Treatment algorithms in systemic lupus erythematosus

Chayawee Muangchan, Ronald F. Van Vollenhoven, Sasha R. Bernatsky, C. Douglas Smith, Marie Hudson, Murat Inanç, Naomi F. Rothfield, Peter T. Nash, Richard A. Furie, Jean Luc Senécal, Vinod Chandran, Ruben Burgos-Vargas, Rosalind Ramsey-Goldman, Janet E. Pope*

*Corresponding author for this work

Research output: Contribution to journalArticle

48 Scopus citations

Abstract

Objective To establish agreement on systemic lupus erythematosus (SLE) treatment. Methods SLE experts (n = 69) were e-mailed scenarios and indicated preferred treatments. Algorithms were constructed and agreement determined (≥50% respondents indicating ≥70% agreement). Results Initially, 54% (n = 37) responded suggesting treatment for scenarios; 13 experts rated agreement with scenarios. Fourteen of 16 scenarios had agreement as follows: discoid lupus: first-line therapy was topical agents and hydroxychloroquine and/or glucocorticoids then azathioprine and subsequently mycophenolate (mofetil); uncomplicated cutaneous vasculitis: initial treatment was glucocorticoids ± hydroxychloroquine ± methotrexate, followed by azathioprine or mycophenolate and then cyclophosphamide; arthritis: initial therapy was hydroxychloroquine and/or glucocorticoids, then methotrexate and subsequently rituximab; pericarditis: first-line therapy was nonsteroidal antiinflammatory drugs, then glucocorticoids with/without hydroxychloroquine, then azathioprine, mycophenolate, or methotrexate and finally belimumab or rituximab, and/or a pericardial window; interstitial lung disease/alveolitis: induction was glucocorticoids and mycophenolate or cyclophosphamide, then rituximab or intravenous gamma globulin (IVIG), and maintenance followed with azathioprine or mycophenolate; pulmonary hypertension: glucocorticoids and mycophenolate or cyclophosphamide and an endothelin receptor antagonist were initial therapies, subsequent treatments were phosphodiesterase-5 inhibitors and then prostanoids and rituximab; antiphospholipid antibody syndrome: standard anticoagulation with/without hydroxychloroquine, then a thrombin inhibitor for venous thrombosis, versus adding aspirin or platelet inhibition drugs for arterial events; mononeuritis multiplex and central nervous system vasculitis: first-line therapy was glucocorticoids and cyclophosphamide followed by maintenance with azathioprine or mycophenolate, and then rituximab, IVIG, or plasmapheresis; and serious lupus nephritis: first-line therapy was glucocorticoids and mycophenolate, then cyclophosphamide then rituximab. Conclusion We established variable agreement on treatment approaches. For some treatment decisions there was good agreement between experts even if no randomized controlled trial data were available.

Original languageEnglish (US)
Pages (from-to)1237-1245
Number of pages9
JournalArthritis Care and Research
Volume67
Issue number9
DOIs
StatePublished - Sep 1 2015

ASJC Scopus subject areas

  • Rheumatology

Fingerprint Dive into the research topics of 'Treatment algorithms in systemic lupus erythematosus'. Together they form a unique fingerprint.

  • Cite this

    Muangchan, C., Van Vollenhoven, R. F., Bernatsky, S. R., Smith, C. D., Hudson, M., Inanç, M., Rothfield, N. F., Nash, P. T., Furie, R. A., Senécal, J. L., Chandran, V., Burgos-Vargas, R., Ramsey-Goldman, R., & Pope, J. E. (2015). Treatment algorithms in systemic lupus erythematosus. Arthritis Care and Research, 67(9), 1237-1245. https://doi.org/10.1002/acr.22589