Definition and application of systemic lupus erythematosus disease modification in emerging markets: Delphi panel consensus recommendations

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.

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Journal
Lupus
Published
2025-06-06
DOI
https://doi.org/10.1177/09612033251347341
Primary Topic
Systemic Lupus Erythematosus Research
Type
article
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article

Definition and application of systemic lupus erythematosus disease modification in emerging markets: Delphi panel consensus recommendations

Ibrahim A. Al-Homood, Juan M. Mejía‐Vilet, Gabriel Teixeira Montezuma Sales, Marina Scolnik et al.
Lupus
Systemic Lupus Erythematosus Research
article

Definition and application of systemic lupus erythematosus disease modification in emerging markets: Delphi panel consensus recommendations

Ibrahim A. Al-Homood, Juan M. Mejía‐Vilet, Gabriel Teixeira Montezuma Sales, Marina Scolnik, Ibrahim A. AlMaghlouth, Raef Gouhar, Guillermo Pons‐Estel, Humaid Al Wahshi, Emily Figueiredo Neves Yuki, Suzan Attar, Munther A. Khamashta, Odirlei André Monticielo, Humeira Badsha, Mercedes García, Alhussain Asiri, Alejandra Magdalena Babini, Gabriel Medrano-Ramírez, Saadeya Abdulkarim, Luciana Parente Costa Seguro, Edgard Torres dos Reis-Neto, Zeyad Alzahrani, Rafat Hussain, Reem Al-Jayyousi, Sebastián Magri, Bruno Simas da Rocha, Faisal Elbadawi
article en

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.

LupusVol. 34(9)
Universidade Federal do Rio Grande do Sul (BR), King Abdulaziz University (SA), King Saud bin Abdulaziz University for Health Sciences (SA), Salmaniya Medical Complex (BH), King Fahd Medical City (SA), King Saud University (SA), Dubai Hospital (AE), Hospital Italiano de Buenos Aires (AR), Hospital General de México (MX), Hospital de Clínicas de Porto Alegre (BR), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (MX), Mohammed Bin Rashid University of Medicine and Health Sciences (AE), Hospital Provincial de Rosario (AR), Hospital Italiano La Plata (AR), Royal Hospital (OM), Servicio Diabetología Hospital Córdoba (AR), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (BR), Dubai Medical College (AE), GlaxoSmithKline (Brazil) (BR), Asir Central Hospital (SA), National Guard Health Affairs (SA), Universidade Federal de São Paulo (BR)
Openalex Percentile: Top 80%
Systemic Lupus Erythematosus Research
DOISourceOpenAlex
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