Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus

Abstract

Objective To formulate consensus treatment plans (CTPs) for induction therapy of newly-diagnosed proliferative lupus nephritis (LN) in juvenile systemic lupus erythematosus (jSLE). Methods A structured consensus formation process was employed by the members of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) after considering the existing medical evidence and current treatment approaches. Results After an initial Delphi survey (response rate 70%), a 2-day consensus conference, and two follow-up Delphi surveys (response rates 63–79%), consensus was achieved for a limited set of CTPs addressing the induction therapy of proliferative LN. These CTPs were developed for prototypic patients defined by eligibility characteristics, and included immunosuppressive therapy with either mycophenolic acid orally twice per day, or intravenous cyclophosphamide once per month at standardized doses for six months. Additionally, the CTPs describe three options for standardized use of glucocorticoids; including a primarily oral, a mixed oral/intravenous, and a primarily intravenous regimen. There was consensus on measures of effectiveness and safety of the CTPs. The CTPs were well accepted by the pediatric rheumatology providers treating children with LN, and up to 300 children per year in North America are expected to be candidates for the treatment with the CTPs. Conclusion CTPs for induction therapy of proliferative LN in jSLE based on the available scientific evidence and pediatric rheumatology group experience have been developed. Consistent use of the CTPs may improve the prognosis of proliferative LN, and support the conduct of comparative effectiveness studies aimed at optimizing therapeutic strategies for proliferative LN in jSLE.

Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines

“…The Systemic Lupus Erythrematosus Disease Activity Index was the only tool specified for adults (13) and adolescents (15).…”

“…Six guidelines provided recommendations on monitoring disease activity, disease damage, and quality of life (10)(11)(12)(13)(14)(15).…”

Review of International Registers of Patients with Systemic Juvenile Idiopathic Arthritis

“…В регистр включаются педиатрические пациенты с ревматическими болезнями [15]. На сегод-няшний день в регистр CARRA включены сведения о 9525 пациентах с ревматическими болезнями, из них около 6500 детей с ЮИА.…”

“…В рамках регистра проводятся исследования эффективности ГИБП при ревматических болезнях у детей, изучение особенностей болевого синдрома, влияния терапии ГИБП на физическую актив-ность и состояние здоровья пациентов с различными вариантами ЮИА и др. [15]. На основе данных регистра CARRA также проводился анализ частоты развития жиз-неугрожающих осложнений у пациентов с сЮИА.…”

“…В схемы лечения включены только ГКС или метотрексат, анакинра или тоцилизумаб с/без ГКС. Для оценки эффективности 4 схем терапии у детей стан-дартизованы графики клинического и лабораторного мониторинга, которые могут применяться в клиниче-ской практике [15].…”