Real-world treatment of juvenile-onset systemic lupus erythematosus (JSLE) included 2 or more immunomodulators for the majority of patients, with mycophenolate mofetil as the most common first- and second-line treatment, according study results published in Clinical Immunology.

Researchers evaluated real-world treatment strategies of children with JSLE, including the choice and sequence of immunomodulating drugs from diagnosis. This data will inform the future development of a JSLE treat-to-target clinical trial.

Study participants included patients diagnosed with JSLE before the age of 18 years who were identified from the UK JSLE Cohort Study. Demographics, clinical and laboratory data. Medications were collected at baseline and longitudinally between July 2009 and May 2020. Disease activity was calculated using the pediatric British Isles Lupus Assessment Grade 2004 score. Multivariate logistic regression analyses were performed to investigate which treatments were used for different types of organ domain involvement.


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A total of 349 patients (83% girls) were followed for a median of 4 years. Mycophenolate mofetil was the most common immunomodulatory treatment for most types of organ system involvement, except gastrointestinal and ophthalmic domains. Specifically, mycophenolate mofetil was significantly associated with renal involvement (odds ratio [OR]=1.99; 95% CI, 1.65-2.41; P <.01).

A subcohort of 197 patients with a median follow-up of 3 years were included in the sequence analysis. Of these, 10 (5%) received hydroxychloroquine and prednisolone, 62 (31%) received 1 immunomodulator, 69 (36%) received 2 immunomodulators, and 56 (28%) received 3 or more immunomodulators during follow-up. Mycophenolate mofetil was the most common first- and second-line treatment, while rituximab was the most common third-line treatment.

Limitations of the study included missing or incomplete data, patients lost to follow-up, limited access of patients to some treatments, and a lack of data on the reasons for treatment changes.

The researchers concluded, “Observations from this study on ‘real world treatment practices’ will be considered alongside the literature during the development of [treat-to-target] study treatment algorithms as part of the [future] research programme.”

Reference

Smith EMD, Egbivwie N, Jorgensen AL, et al. Real world treatment of juvenile-onset systemic lupus erythematosus: Data from the UK JSLE cohort study. Clin Immunol. Published online May 2, 2022. doi:10.1016/j.clim.2022.109028