Treatment Algorithms in Systemic Lupus Erythematosus.

Area of Science:

• Rheumatology
• Immunology
• Internal Medicine

Background:

• Systemic lupus erythematosus (SLE) is a complex autoimmune disease requiring nuanced treatment strategies.
• Establishing consensus on optimal SLE management is crucial for improving patient outcomes.
• Current treatment guidelines often lack definitive evidence for specific clinical scenarios.

Purpose of the Study:

• To achieve expert consensus on preferred treatment algorithms for various manifestations of SLE.
• To identify areas of agreement and disagreement among SLE specialists regarding therapeutic choices.
• To inform clinical practice by providing evidence-based recommendations where data is limited.

Main Methods:

• A Delphi-like method involving 69 SLE experts who responded to clinical scenarios via email.
• Development of treatment algorithms based on expert-indicated preferences.
• Determination of expert agreement using a threshold of ≥50% respondents indicating ≥70% agreement.

Main Results:

• An initial response rate of 54% (37 experts) was achieved.
• Agreement was established for 14 out of 16 scenarios, covering discoid lupus, cutaneous vasculitis, arthritis, pericarditis, interstitial lung disease, pulmonary hypertension, antiphospholipid antibody syndrome, neurological involvement, and lupus nephritis.
• Specific treatment sequences were outlined, including first-line, second-line, and subsequent therapies, often involving agents like hydroxychloroquine, glucocorticoids, mycophenolate mofetil, azathioprine, cyclophosphamide, rituximab, and belimumab.

Conclusions:

• Variable agreement exists among experts on SLE treatment strategies.
• Consensus was achieved for several treatment decisions, highlighting areas where expert opinion can guide practice.
• These findings provide valuable insights for managing SLE, particularly in situations lacking robust randomized controlled trial data.