Practice pattern variation in oral glucocorticoid therapy after the induction of response in proliferative lupus nephritis
| Autor: | D. R. W. Jayne, Michael Walsh, Marcello Tonelli, Neesh Pannu, Louise Moist, Braden J. Manns |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
Practice patterns business.industry Lupus nephritis Administration Oral medicine.disease Lupus Nephritis Rheumatology Glucocorticoid therapy Surveys and Questionnaires Internal medicine medicine Humans Practice Patterns Physicians' business Glucocorticoids Nephritis Standard therapy Glucocorticoid medicine.drug |
| Zdroj: | Lupus. 19:628-633 |
| ISSN: | 1477-0962 0961-2033 |
| Popis: | Glucocorticoids are standard therapy for induction of response in proliferative lupus nephritis. However, the optimal duration of glucocorticoid therapy is uncertain. We surveyed physicians who treat lupus nephritis regarding their use of glucocorticoids in proliferative lupus nephritis after induction of response and regarding factors associated with different practice patterns. We administered a questionnaire of standardized cases assessing glucocorticoid use after induction of response to specialists with expertise in proliferative lupus nephritis. We examined the association between continuation of glucocorticoids and patient and physician characteristics. Of 90 invited participants, 72 (80%) responded. A total of 24 (33%) respondents attempted to discontinue glucocorticoids in all scenarios, 21 (29%) continued glucocorticoids in all scenarios, and 27 (38%) attempted to discontinue in some scenarios but not others. Responses varied according to the physician group (p < 0.001) and by years in practice (p < 0.001). Of those who discontinued glucocorticoids in selected scenarios, 15/27 (55%) were influenced by the characteristics of the induction of response, 16/27 (59%) by past lupus history, and 9/27 (33%) by the tolerance and use of immunosuppression. We conclude that glucocorticoid therapy after induction of response in proliferative lupus nephritis is varied. This variability likely represents clinical equipoise. A randomized trial evaluating the effect of glucocorticoid use after induction of response is warranted. |
| Databáze: | OpenAIRE |
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