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Clinicians approaches to management of background treatment in patients with SLE in clinical remission: results of an international observational survey

BACKGROUND: The definition of remission in systemic lupus erythematosus (SLE) remains unclear, especially how background treatment should be interpreted. OBJECTIVE: To determine preferences of clinicians in treatment of patients in clinical remission from SLE and to assess how previous severity, dur...

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Autores principales: Ngamjanyaporn, Pintip, McCarthy, Eoghan M, Sergeant, Jamie C, Reynolds, John, Skeoch, Sarah, Parker, Benjamin, Bruce, Ian N
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724341/
https://www.ncbi.nlm.nih.gov/pubmed/29238601
http://dx.doi.org/10.1136/lupus-2016-000173
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author Ngamjanyaporn, Pintip
McCarthy, Eoghan M
Sergeant, Jamie C
Reynolds, John
Skeoch, Sarah
Parker, Benjamin
Bruce, Ian N
author_facet Ngamjanyaporn, Pintip
McCarthy, Eoghan M
Sergeant, Jamie C
Reynolds, John
Skeoch, Sarah
Parker, Benjamin
Bruce, Ian N
author_sort Ngamjanyaporn, Pintip
collection PubMed
description BACKGROUND: The definition of remission in systemic lupus erythematosus (SLE) remains unclear, especially how background treatment should be interpreted. OBJECTIVE: To determine preferences of clinicians in treatment of patients in clinical remission from SLE and to assess how previous severity, duration of remission and serology influence changes in treatment. METHODS: We undertook an internet-based survey of clinicians managing patients with SLE. Case scenarios were constructed to reflect different remission states, previous organ involvement, serological abnormalities, duration of remission and current treatment (hydroxychloroquine (HCQ), steroids and/or immunosuppressive (ISS) agents). RESULTS: 130 clinicians from 30 countries were surveyed. The median (range) duration of practice and number of patients with SLE seen each month was 13 (2–42) years and 30 (2–200), respectively. Management decisions in all scenarios varied with greater caution in treatment reduction with shorter duration of remission, extent of serological abnormalities and previous disease severity. Even with mild disease, normal serology and a 5-year clinical remission, 113 (86.9%) clinicians continue to prescribe HCQ. Persistent abnormal serology in any scenario led to a reluctance to reduce or discontinue medications. Prescribing in remission, particularly of steroids and HCQ, varied significantly according to geographical location. CONCLUSIONS: Clinicians preferences in withdrawing or reducing treatment in patients with SLE in clinical remission vary considerably. Serological abnormalities, previous disease severity and duration of remission all influence the decision to reduce treatment. It is unusual for clinicians to stop HCQ even after prolonged periods of clinical remission. Any definition(s) of remission needs to take into consideration such evidence on how maintenance treatments are managed.
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spelling pubmed-57243412017-12-13 Clinicians approaches to management of background treatment in patients with SLE in clinical remission: results of an international observational survey Ngamjanyaporn, Pintip McCarthy, Eoghan M Sergeant, Jamie C Reynolds, John Skeoch, Sarah Parker, Benjamin Bruce, Ian N Lupus Sci Med Epidemiology and Outcomes BACKGROUND: The definition of remission in systemic lupus erythematosus (SLE) remains unclear, especially how background treatment should be interpreted. OBJECTIVE: To determine preferences of clinicians in treatment of patients in clinical remission from SLE and to assess how previous severity, duration of remission and serology influence changes in treatment. METHODS: We undertook an internet-based survey of clinicians managing patients with SLE. Case scenarios were constructed to reflect different remission states, previous organ involvement, serological abnormalities, duration of remission and current treatment (hydroxychloroquine (HCQ), steroids and/or immunosuppressive (ISS) agents). RESULTS: 130 clinicians from 30 countries were surveyed. The median (range) duration of practice and number of patients with SLE seen each month was 13 (2–42) years and 30 (2–200), respectively. Management decisions in all scenarios varied with greater caution in treatment reduction with shorter duration of remission, extent of serological abnormalities and previous disease severity. Even with mild disease, normal serology and a 5-year clinical remission, 113 (86.9%) clinicians continue to prescribe HCQ. Persistent abnormal serology in any scenario led to a reluctance to reduce or discontinue medications. Prescribing in remission, particularly of steroids and HCQ, varied significantly according to geographical location. CONCLUSIONS: Clinicians preferences in withdrawing or reducing treatment in patients with SLE in clinical remission vary considerably. Serological abnormalities, previous disease severity and duration of remission all influence the decision to reduce treatment. It is unusual for clinicians to stop HCQ even after prolonged periods of clinical remission. Any definition(s) of remission needs to take into consideration such evidence on how maintenance treatments are managed. BMJ Publishing Group 2017-06-29 /pmc/articles/PMC5724341/ /pubmed/29238601 http://dx.doi.org/10.1136/lupus-2016-000173 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Epidemiology and Outcomes
Ngamjanyaporn, Pintip
McCarthy, Eoghan M
Sergeant, Jamie C
Reynolds, John
Skeoch, Sarah
Parker, Benjamin
Bruce, Ian N
Clinicians approaches to management of background treatment in patients with SLE in clinical remission: results of an international observational survey
title Clinicians approaches to management of background treatment in patients with SLE in clinical remission: results of an international observational survey
title_full Clinicians approaches to management of background treatment in patients with SLE in clinical remission: results of an international observational survey
title_fullStr Clinicians approaches to management of background treatment in patients with SLE in clinical remission: results of an international observational survey
title_full_unstemmed Clinicians approaches to management of background treatment in patients with SLE in clinical remission: results of an international observational survey
title_short Clinicians approaches to management of background treatment in patients with SLE in clinical remission: results of an international observational survey
title_sort clinicians approaches to management of background treatment in patients with sle in clinical remission: results of an international observational survey
topic Epidemiology and Outcomes
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724341/
https://www.ncbi.nlm.nih.gov/pubmed/29238601
http://dx.doi.org/10.1136/lupus-2016-000173
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