Cognitive Behavioral Therapy for Youth With Childhood-Onset Lupus: A Randomized Clinical Trial

Our objective was to determine the feasibility and acceptability of the Treatment and Education Approach for Childhood-Onset Lupus (TEACH), a six-session cognitive behavioral intervention addressing depressive, fatigue, and pain symptoms, delivered remotely to individual youth with lupus by a trained interventionist. We expected that TEACH would be considered feasible and acceptable based on recruitment and retention rates. We also examined the effect of TEACH on youths' depressive, fatigue, and pain symptoms compared to medical treatment as usual (TAU).

A pilot two-arm longitudinal randomized controlled clinical trial was conducted. Adolescents (12-17 years) and young adults (18-22 years) with childhood-onset systemic lupus erythematosus and elevated depressive, fatigue, and/or pain symptoms were recruited from six pediatric rheumatology sites across the United States and Canada from August 2020 to March 2023. Participants were randomized 1:1 to TEACH and TAU or TAU alone and reported symptom data at baseline and eight weeks later.

Of the 200 youth approached, 97 consented to participate (48.5% recruitment). Among 64 eligible participants, 32 were randomized to TEACH and TAU and 32 to TAU alone. Retention was high (92.2%). At postassessment, the intervention group demonstrated reductions in depressive (C_emm 7.88, 95% confidence interval 3.20-12.60; 14%) and fatigue (C_emm 3.91, 95% confidence interval 0.44-7.39; 7%) symptoms but not pain (C_emm 0.89, 95% confidence interval -0.06 to 1.84).

This remotely delivered cognitive behavioral intervention tailored to youth with lupus was feasible and associated with reduced depressive and fatigue symptoms compared with medical TAU. Further increasing accessibility by implementing TEACH in medical settings may improve uptake and patient outcomes.