nternational Consensus for the Dosing of Corticosteroids in Childhood-Onset Systemic Lupus Erythematosus With Proliferative Lupus Nephriti

Author(s):Show less -

Chalhoub, Nathalie E. ^[1] ; Wenderfer, Scott E. ^[2] ; Levy, Deborah M. ^{[3, 4]} ; Rouster-Stevens, Kelly ^{[5, 6]} ; Aggarwal, Amita ^[7] ; Savani, I, Sonia ; Ruth, Natasha M. ^[8] ; Arkachaisri, Thaschawee ^[9] ; Qiu, Tingting ^[10] ; Merritt, Angela ^[10] ; Onel, Karen ^[11] ; Goilav, Beatrice ^[12] ; Khubchandani, Raju P. ^[13] ; Deng, Jianghong ^{[14, 15]} ; Fonseca, Adriana R. ^[16] ; Ardoin, Stacy P. ^[17] ; Ciurtin, Coziana ^[18] ; Kasapcopur, Ozgur ^[19] ; Jelusic, Marija ^[20] ; Huber, Adam M. ^{[21, 22]} ; Ozen, Seza ^[23] ; Klein-Gitelman, Marisa S. ^{[24, 25]} ; Appenzeller, Simone ^[26] ; Cavalcanti, Andre ^[27] ; Fotis, Lampros ^[28] ; Lim, Sern Chin ^[29] ; Silva, Rodrigo M. ^[16] ; Ramirez-Miramontes, Julia ^[30] ; Rosenwasser, Natalie L. ^{[31, 32]} ; Saad-Magalhaes, Claudia ^[33] ; Schonenberg-Meinema, Dieneke ^[34] ; Scott, Christiaan ^{[35, 36]} ; Silva, Clovis A. ^[37] ; Enciso, Sandra ^[38] ; Terreri, Maria T. ^[39] ; Torres-Jimenez, Alfonso-Ragnar ^[40] ; Trachana, Maria ^[41] ; Al-Mayouf, Sulaiman M. ^{[42, 43]} ; Devarajan, Prasad ^{[1, 10]} ; Huang, Bin ^{[1, 10]} ; Brunner, I, Hermine

Affiliation:Show less -

^[1] I, Univ Cincinnati, Coll Med, Cincinnati, OH - USA

^[2] Baylor Coll Med, Houston, TX 77030 - USA

^[3] Univ Toronto, Toronto, ON - Canada

^[4] Hosp Sick Children, Toronto, ON - Canada

^[5] Emory Univ, Atlanta, GA 30322 - USA

^[6] Childrens Healthcare Atlanta, Atlanta, GA - USA

^[7] Sanjay Gandhi Postgrad Inst Med Sci, Lucknow, Uttar Pradesh - India

^[8] Savani, Sonia, I, Med Univ South Carolina, Charleston, SC 29425 - USA

^[9] KK Womens & Childrens Hosp, Singapore - Singapore

^[10] I, Cincinnati Childrens Hosp Med Ctr, 3333 Burnet Ave, MLC 4010, Cincinnati, OH 45229 - USA

^[11] Hosp Special Surg, 535 E 70th St, New York, NY 10021 - USA

^[12] Albert Einstein Coll Med, New York, NY - USA

^[13] SRCC Childrens Hosp, Mumbai, Maharashtra - India

^[14] Capital Med Univ, Beijing - Peoples R China

^[15] Natl Ctr Childrens Hlth, Beijing - Peoples R China

^[16] Univ Fed Rio de Janeiro, Rio De Janeiro - Brazil

^[17] Nationwide Childrens Hosp, Columbus, OH - USA

^[18] UCL, London - England

^[19] Istanbul Univ Cerrahpasa, Cerrahpasa Med Sch, Istanbul - Turkey

^[20] Univ Zagreb, Sch Med, Zagreb - Croatia

^[21] Dalhousie Univ, Halifax, NS - Canada

^[22] IWK Hlth Ctr, Halifax, NS - Canada

^[23] Hacettepe Univ, Ankara - Turkey

^[24] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 - USA

^[25] Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL 60611 - USA

^[26] Univ Estadual Campinas, Campinas - Brazil

^[27] Univ Fed Pernambuco, Hosp Clin, Recife, PE - Brazil

^[28] Natl & Kapodistian Univ Athens, Athens - Greece

^[29] Univ Teknol MARA, Sungaig Buloh - Malaysia

^[30] Inst Mexicano Seguro Social, Monterrey - Mexico

^[31] Univ Washington, Seattle, WA 98195 - USA

^[32] Seattle Childrens Hosp, Seattle, WA - USA

^[33] Sao Paulo State Univ, Botucatu, SP - Brazil

^[34] Amsterdam Univ Med Ctr, Amsterdam - Netherlands

^[35] Univ Cape Town, Cape Town - South Africa

^[36] Red Cross War Mem Childrens Hosp, Cape Town - South Africa

^[37] Univ Sao Paulo, Sao Paulo - Brazil

^[38] Hosp Beneficencia Espanola, Mexico City, DF - Mexico

^[39] Univ Fed Sao Paulo, Sao Paulo - Brazil

^[40] Natl Med Ctr La Raza, Mexico City, DF - Mexico

^[41] Aristotle Univ Thessaloniki, Thessaloniki - Greece

^[42] King Faisal Specialist Hosp & Res Ctr, Riyadh - Saudi Arabia

^[43] Alfaisal Univ, Riyadh - Saudi Arabia

• Document type: Journal article
• Source: ARTHRITIS & RHEUMATOLOGY; v. 74, n. 2 JAN 2022.
• Web of Science Citations: 0

Abstract

Objective To develop a standardized steroid dosing regimen (SSR) for physicians treating childhood-onset systemic lupus erythematosus (SLE) complicated by lupus nephritis (LN), using consensus formation methodology. Methods Parameters influencing corticosteroid (CS) dosing were identified (step 1). Data from children with proliferative LN were used to generate patient profiles (step 2). Physicians rated changes in renal and extrarenal childhood-onset SLE activity between 2 consecutive visits and proposed CS dosing (step 3). The SSR was developed using patient profile ratings (step 4), with refinements achieved in a physician focus group (step 5). A second type of patient profile describing the course of childhood-onset SLE for >= 4 months since kidney biopsy was rated to validate the SSR-recommended oral and intravenous (IV) CS dosages (step 6). Patient profile adjudication was based on majority ratings for both renal and extrarenal disease courses, and consensus level was set at 80%. Results Degree of proteinuria, estimated glomerular filtration rate, changes in renal and extrarenal disease activity, and time since kidney biopsy influenced CS dosing (steps 1 and 2). Considering these parameters in 5,056 patient profile ratings from 103 raters, and renal and extrarenal course definitions, CS dosing rules of the SSR were developed (steps 3-5). Validation of the SSR for up to 6 months post-kidney biopsy was achieved with 1,838 patient profile ratings from 60 raters who achieved consensus for oral and IV CS dosage in accordance with the SSR (step 6). Conclusion The SSR represents an international consensus on CS dosing for use in patients with childhood-onset SLE and proliferative LN. The SSR is anticipated to be used for clinical care and to standardize CS dosage during clinical trials. (AU)

• FAPESP's process: 15/03756-4 - Assessment of relevance of blood levels of drugs in the monitoring rheumatic autoimmune diseases: safety, effectiveness and adherence to therapy
• Grantee: Eloisa Silva Dutra de Oliveira Bonfá
• Support Opportunities: Research Projects - Thematic Grants