Background The Asia-Pacific League of Associations for Rheumatology (APLAR) recently published consensus recommendations, including overarching principles, general management, and specific treatment strategies for SLE in Asia. The use of hydroxychloroquine (HCQ) in all SLE patients was recommended unless contraindicated (statement 7).1 We evaluated the current therapeutic practice with respect to anti-malarial use in the Asia Pacific region against this recommendation.
Methods We used data from the Asia Pacific Lupus Collaboration (APLC) cohort, collected from SLE patients (meeting either ACR or SLICC criteria) between 2013 and 2020. Disease activity (SLEDAI-2K) and medication details were captured at enrolment and at routine visits. We defined medication categories based on glucocorticoid (GC), anti-malarial (AM) and immunosuppressant (IS) use at each visit and examined them in relation to clinical and serological disease activity.
Results We analysed 4,086 patients and 41,653 visits of data. Patients had no disease activity (i.e. SLEDAI-2K=0) in 25.5% of visits; clinical activity alone in 12.7% of visits; serological activity alone in 34.8% of visits, and both clinical and serological activity on 27% of visits. Regardless of disease activity, 78% of all patient visits were on GC, 67% on AM and 61% on IS. These proportions varied significantly among countries (figure 1). With regard to AM use, the majority was HCQ (62% of all visits) and a minority on chloroquine (4%).
Conclusions AM use was suboptimal and varied significantly across Asia Pacific countries There are disparities between current practice and Asia-Pacific SLE management guidelines, highlighting the need for knowledge dissemination.
Mok CC, Hamijoyo L, Kasitanon N, Chen DY, Chen S, Yamaoka K, et al. The Asia-Pacific League of Associations for Rheumatology consensus statements on the management of systemic lupus erythematosus. The Lancet Rheumatology. 2021;3(7):E517-E531.
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