Insights into Treating Lupus - A Rheum Survey  Save

RheumNow recently surveyed clinicians to better understand current practice patterns, educational needs, and barriers to the use of new, advanced therapies in systemic lupus erythematosus (SLE). A total of 197 clinicians completed the survey.

A total of 197 responses were collected: 122 from the US (63%) and 72 from outside the US (37%), representing 35 countries.

Survey respondents represented a mix of hospital-based (28.6%), private practice (24%), academic (24%), and community-based (19%) practices. Respondents were generally experienced, with over half (57.1%) reporting more than 10 years in practice and 14.3% having more than 30 years of experience.

Below is their responses to seven questions on lupus therapy.

Does a lupus nephritis indication influence treatment beyond nephritis (of non-renal SLE)?

Most rheumatologists (69%) felt that a “lupus nephritis” indication was valuable when treating anon-renal lupus.

• Highly valuable — 52%
• Somewhat valuable — 27%
• Not very valuable — 12%
• Not valuable — 9%

These findings suggest more weight is given to a lupus nephritis indication when considering therapies across the broader spectrum of SLE manifestations.

When treating non-renal SLE, when would you introduce advanced therapy?

When treating non-renal lupus, respondents reported they would typically introduce advanced therapy after failing another drug:

• After ≥1 immunosuppressant failure — 60%
• After antimalarials but before immunosuppressants — 31%
• Only in patients with high-dose steroid dependence %

These responses indicate an adherence to a traditional stepwise treatment strategy. As much as a third would consider earlier use of other therapies before immunosuppressants.

Under what circumstances would you consider an advanced therapy before immunosuppressants in non-renal lupus patients?

Clinicians have multiple reasons to individualize treatment, with lab findings being least important. Equally valid were intolerance/contraindications (to immunosuppressants), steroid dependence, disease flares, and skin or joint activity. Hence both drug tolerance and disease burden are primary drivers of treatment escalation.

• Intolerance or contraindication to immunosuppressants — 29%
• Persistent steroid dependence — 25%
• Frequent or severe flares — 23%
• Severe skin or joint disease — 19%
• Lab abnormalities — 4% 

What is the biggest barrier to initiating advanced therapies earlier in SLE?

The biggest barriers to initiating advanced therapies earlier in SLE included:

• Patient hesitancy — 31%
• Safety concerns — 23%
• Available administration (e.g., SQ, IV) — 21%
• Lack of sufficient evidence — 14%
• Fear of exhausting treatment options early — 11%

Patient acceptance remains the leading challenge to earlier treatment initiation. Safety concerns and confidence in the available evidence also continue to influence treatment decisions, suggesting opportunities for both physician and patient education.

In the future, how will you stay abreast of advances in lupus treatments?

Respondents indicated they plan to stay current with new SLE therapies through:

• ACR or EULAR — 65%
• Rheumatology societies or organizations —11%
• Regional rheumatology meetings — 10%
• Social media — 7%
• CME lectures — 6%

While two-thirds rely on large congresses, 27% are dependent on local/regional educational venues to stay up to date.

What topics would you value learning most, with the introduction of new types of treatments for SLE?

Respondents appear to be looking for practical guidance when learning about new therapies and how they should be incorporated into clinical practice. Clinical trial data, especially in the context of guidelines and strategies are most impactful educationally. When asked what topics would be most valuable with the introduction of new SLE therapies, respondents selected:

• Guidelines or best practices — 39%
• Clinical trial data — 38%
• New treatment strategies — 16%
• Mechanism of action — 4%
• Safety data — 28%

How often do you manage lupus patients with associated Sjögren's disease ?

Nearly two-thirds of clinicians reported that associated Sjögren's disease (SjD)in up to 24% of their lupus population. However, one-third found SjD an associated management issue in 25-50% of their lupus patients. The estimated proportion of their lupus patients who also require treatment for associated Sjögren's disease are:

• <10% — 31%
• 10–24% — 32%
• 25–49% — 13%
• 50% — 22%

Overall

This survey suggests that rheumatologists continue to favor a cautious, stepwise approach to introducing advanced therapies in SLE, while recognizing situations in which earlier intervention may be appropriate. Intolerance to conventional immunosuppressants and persistent steroid dependence were the strongest drivers for earlier treatment, whereas patient hesitancy, safety concerns, and uncertainty around treatment sequencing remain important barriers. Educational efforts focused on practical treatment algorithms, guideline implementation, and interpretation of emerging clinical trial data may help clinicians incorporate new therapies more confidently into routine SLE care.

This survey was sponsored by BMS.