Advancing treat-to-target in SLE: a pilot study using a clinical decision support system.

Area of Science:

• Rheumatology and Immunology
• Health Informatics
• Clinical Trial Design

Background:

• Systemic lupus erythematosus (SLE) management requires proactive treatment adjustments.
• Treat-to-target (T2T) strategies aim to optimize patient outcomes by achieving predefined therapeutic goals.
• Clinical Decision Support Systems (CDSS) can aid clinicians in implementing evidence-based treatment protocols.

Purpose of the Study:

• To assess the feasibility, usability, and acceptability of a T2T strategy for SLE outpatient care.
• To evaluate the impact of a CDSS-supported T2T approach on treatment modifications and patient satisfaction.

Main Methods:

• A 24-week, non-randomized, multicentre pilot study involving adult patients with SLE.
• Patients were assigned to either a T2T strategy with CDSS (T2T-CDSS) or routine outpatient care (ROC).
• Feasibility (recruitment, retention), usability (System Usability Scale), and acceptability (Treatment Satisfaction Questionnaire, qualitative feedback) were assessed. Exploratory outcomes included disease activity and remission rates.

Main Results:

• Recruitment rate was 42% (38/91 patients), with a 92% retention rate (35/38 patients).
• The CDSS demonstrated good usability (SUS score 73.8).
• Treatment intensification and de-escalation (glucocorticoid tapering) occurred more frequently in the T2T-CDSS group; however, no significant differences in disease activity or remission rates were observed between groups.

Conclusions:

• The implementation of a T2T strategy supported by a CDSS is feasible, usable, and acceptable in routine SLE outpatient care.
• The CDSS facilitates proactive, target-driven treatment adjustments, showing promise for goal-directed therapy in SLE.
• Addressing identified implementation barriers is crucial for future large-scale trials.