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. 2024 Mar 1;63(3):657-664.
doi: 10.1093/rheumatology/kead250.

Global disparities in the treatment of idiopathic inflammatory myopathies: results from an international online survey study

Nelly Ziade  1   2 , Marc Aoude  1   2 , Ihsane Hmamouchi  3   4 , Naveen R  5 , James B Lilleker  6   7 , Parikshit Sen  8 , Mrudula Joshi  9 , Vishwesh Agarwal  10 , Sinan Kardes  11 , Jessica Day  12   13   14 , Ashima Makol  15 , Marcin Milchert  16 , Tamer Gheita  17 , Babur Salim  18 , Tsvetelina Velikova  19 , Abraham Edgar Gracia-Ramos  20 , Ioannis Parodis  21   22 , Elena Nikiphorou  23   24 , Tulika Chatterjee  25 , Ai Lyn Tan  26   27 , Miguel A Saavedra  28 , Samuel Katsuyuki Shinjo  29 , Johannes Knitza  30 , Masataka Kuwana  31 , Arvind Nune  32 , Lorenzo Cavagna  33   34 , Oliver Distler  35 , Hector Chinoy  5   36   37 , Vikas Agarwal  4 , Rohit Aggarwal  38 , Latika Gupta  6   39   40 ; COVAD Study Group
Collaborators, Affiliations

Global disparities in the treatment of idiopathic inflammatory myopathies: results from an international online survey study

Nelly Ziade et al. Rheumatology (Oxford). .

Abstract

Objectives: We aimed to explore current practice and interregional differences in the treatment of idiopathic inflammatory myopathies (IIMs). We triangulated these observations considering countries' gross national income (GNI), disease subtypes, and symptoms using patient-reported information.

Methods: A cross-sectional ancillary analysis of the 'COVID-19 vaccination in auto-immune disease' (COVAD) e-survey containing demographic characteristics, IIM subtypes (DM, PM, IBM, anti-synthetase syndrome [ASSD], immune-mediated necrotizing myopathy [IMNM], overlap myopathies [OM]), current symptoms (surrogate for organ involvement) and treatments (corticosteroids [CS], immunomodulators [IM], i.e. antimalarials, immunosuppressants [IS], IVIG, biologic treatments and targeted-synthetic small molecules). Treatments were presented descriptively according to continents, GNI, IIM and organ involvement, and associated factors were analysed using multivariable binary logistic regressions.

Results: Of 18 851 respondents from 94 countries, 1418 with IIM were analysed (age 61 years, 62.5% females). DM (32.4%), IBM (24.5%) and OM (15.8%) were the most common subtypes. Treatment categories included IS (49.4%), CS (38.5%), IM (13.8%) and IVIG (9.4%). Notably, treatments varied across regions, GNI categories (IS mostly used in higher-middle income, IM in lower-middle income, IVIG and biologics largely limited to high-income countries), IIM subtypes (IS and CS associated with ASSD, IM with OM and DM, IVIG with IMNM, and biologic treatments with OM and ASSD) and disease manifestations (IS and CS with dyspnoea). Most inter-regional treatment disparities persisted after multivariable analysis.

Conclusion: We identified marked regional treatment disparities in a global cohort of IIM. These observations highlight the need for international consensus-driven management guidelines considering patient-centred care and available resources.

Keywords: equity; inflammatory myopathies; myositis; rheumatic disease; survey; treatment.

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