Childhood-onset systemic lupus erythematosus (cSLE) is associated with a greater prevalence of lupus nephritis (LN) than adult-onset SLE, necessitating extensive immunosuppression. For a study, researchers compared the low-dose EuroLupus cyclophosphamide (CYC) treatment to the high-dose National Institutes of Health (NIH) CYC protocol in treating LN in cSLE.
Childhood Arthritis and Rheumatology Research Alliance (CARRA) and Pediatric Nephrology Research Consortium (PNRC) clinicians were given a 35-item Web-based survey. The survey looked at participant demographics, CYC prescribing patterns, EuroLupus protocol perceptions, and LN vignette treatment decisions; one vignette was chosen from a 2009 CARRA study, and the results were compared. The utilization of low-dose vs. high-dose CYC was investigated using multivariable logistic regression.
Responses were from 185/421 (44%) pediatric rheumatologists (CARRA) and 40/354 (11%) pediatric nephrologists (PNRC). Half of those who had prescribed CYC for pediatric LN in the previous year (n=135) said they used EuroLupus. When given a similar scenario with a teenager with class IV LN, 32% of pediatric rheumatologists selected EuroLupus dosage in 2020, compared to 6% in 2009. Familiarity with the procedure (OR 4.2, P=0.006) and larger perceived benefit (OR 1.6, P<0.0001) were provider characteristics associated with choosing the low-dose regimen. Pediatric nephrologists responded similarly to pediatric rheumatologists. About 78% of respondents thought the EuroLupus protocol was as effective as the high-dose regimen in cSLE LN.
Pediatric doctors are now more likely than a decade ago to utilize low-dose CYC to treat cSLE LN. Nonetheless, knowledge of EuroLupus dosage remains limited.