Definition and application of systemic lupus erythematosus disease modification in emerging markets: Delphi panel consensus recommendations
- PMID: 40476294
- DOI: 10.1177/09612033251347341
Definition and application of systemic lupus erythematosus disease modification in emerging markets: Delphi panel consensus recommendations
Abstract
ObjectiveTo better understand the acceptance and potential application of the systemic lupus erythematosus (SLE) and lupus nephritis (LN) disease modification framework, which was first proposed in 2022, among experts in the Gulf region and Latin America.MethodsTwo cross-sectional Delphi surveys of a panel of expert SLE physicians were conducted, with a workshop discussion held between the two surveys. Surveys comprised multiple choice and open-response questions. Experts from Argentina, Bahrain, Brazil, Mexico, Oman, Saudi Arabia and United Arab Emirates were selected based on their demonstrated expertise in SLE. Consensus was indicated by >75% agreement among experts in survey responses. Consensus was also evaluated by Gulf and Latin American regions to identify any regional differences.ResultsThere was consensus across all the queried statements on the concept and components of disease modification, with some minor regional differences observed. Experts unanimously agreed that early diagnosis, early referral to a lupus specialist and a multidisciplinary approach are key factors for achieving disease modification and better patient outcomes. Aspects of the published SLE/LN disease modification definition were either 'routinely' (31%) or 'sometimes' (62%) assessed in current clinical practice. A consensus was reached that biomarkers are a key component of evaluating disease modification (91%), but that currently available biomarkers are sub-optimal (96%). There was consensus that immunosuppressants (96%), biologics (92%) and hydroxychloroquine (88%) are disease modifying treatments. Experts from the Gulf, but not Latin America, agreed that glucocorticoids are not disease modifying.ConclusionsThere was strong consensus across experts from the Gulf and Latin America that the concept of disease modification can provide a valuable framework to support clinicians for the management of patients with SLE and LN. Experts emphasised that clear guidance is required for clinicians to apply the disease modification framework to their routine practice, and in varying local healthcare systems.
Keywords: Systemic lupus erythematosus; lupus nephritis; outcome assessment-healthcare; quality indicators-healthcare.
Conflict of interest statement
Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: GJPE received payment or honoraria for presentations, advisory board, support to participate in educational events and research support/grants from AstraZeneca, Boehringer Ingelheim, GSK, Janssen-Cilag, Novartis, Pfizer, RemeGen and Werfen. OAM received payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AbbVie, APSEN, AstraZeneca, Boehringer Ingelheim, Celltrion, GSK, Janssen-Cilag, Novartis, and UCB; participated on a Data Safety Monitoring Board or Advisory Board for AstraZeneca, Boehringer Ingelheim, Celltrion, GSK. ETRN received speaker fees and/or consultancies from AstraZeneca, GSK and Novartis and participated in clinical research from Abbvie, BMS and Novartis. JMM-V gave academic talks for AstraZeneca, Boehringer Ingelheim, GSK and Roche; received traveling support from GSK to participate in this panel. IA-H and AA received honoraria for speaking from GSK, Novartis, AbbVie, Pfizer, AstraZeneca and Sandoz. RAJ received lecture fees from GSK and Vifor. LPCS has participated as a speaker for GSK and AstraZeneca, received research support from GSK and AstraZeneca and was an investigator of BMS and Abbvie Clinical Trials. SMA received speaker, research grants & advisory honorarium from AbbVie, Amgen, AstraZeneca, BMS, GSK, Gilead, Hikma, Janssen, Eli Lilly, Novartis, Organon, Pfizer, Roche, Sandoz, Sanofi & Takeda. MG has participated as a speaker for GSK, received research support from GSK and was an investigator of BMS and Abbvie Clinical Trials. AB received honoraria for lectures from GSK, AbbVie, Boehringer Ingelheim, Tecnofarma and AstraZeneca. IA no conflicts of interest to disclose. MS received grants from GSK and Janssen, consulting fees: from Janssen, AstraZeneca, and GSK, speaker from GSK, Pfizer, Roche, AstraZeneca and Janssen and support for meeting attendance/travel from Roche and AstraZeneca. SJM received consulting fees, payment or honoraria for lectures, presentations, speakers bureaus, educational events, and payment for expert testimony from Abbvie, AstraZeneca, GSK, Biosidus and Boehringer Ingelheim. EFNY has participated as a speaker for AstraZeneca. GTMS received grants, consulting fees or has participated as a speaker and/or advisor for Boehringer Ingelheim, GSK and Baxter. GM-R no conflicts of interest to disclose. HB received speaker fees and honoraria from Pfizer, Abbvie, Novartis, Lilly, Newbridge and Jannsen. FE has received research support from GSK. HAAW provided research support to the GSK sponsored LUNELORD study; currently president of Oman Society of Rheumatology (unpaid). ZA received honoraria for lectures and a presentation from GSK. SA has received speaker fees, research grants, and advisory honoraria from AbbVie, Amgen, AstraZeneca, BMS, Gilead, GSK, Hikma, Janssen, Lilly, Novartis, Organon, Pfizer, Roche, Sandoz, Sanofi and Takeda. BR is employed by GSK. RH, RG, and MK are employed by GSK and hold financial equities in the company.