Título: "Treatment Algorithms in Systemic Lupus Erythematosus"
Autores: 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, and Janet E. Pope.
Arthritis Care & Research
Vol. 67, No. 9, September 2015, pp 1237–1245
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 con- structed 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 hydroxy- chloroquine and/or glucocorticoids then azathioprine and subsequently mycophenolate (mofetil); uncomplicated cutane- ous 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 fol- lowed with azathioprine or mycophenolate; pulmonary hypertension: glucocorticoids and mycophenolate or cyclophos- phamide 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 inhibi- tion drugs for arterial events; mononeuritis multiplex and central nervous system vasculitis: first-line therapy was gluco- corticoids 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.