OA20 Differences in management approaches for lupus nephritis within the UK

Abstract

Abstract Background/Aims Outcomes of current therapy for lupus nephritis (LN) are suboptimal. Guidelines offer varied options for treatment of LN at onset, for refractory disease or relapse. Recent randomised trials have demonstrated the efficacy of newer agents and combination therapies, although these are not all permitted within NICE or NHS England funding. Therefore, treatment strategy may vary between clinicians or regions. We aimed to describe variations in usual practice of UK physicians who treat LN. Methods We conducted an online survey of simulated LN case scenarios for rheumatologists and nephrologists within the UK to identify treatment preferences for proliferative (class IV) and membranous (class V) LN. Results Of 77 respondents who completed the survey 48 (62.3%) were rheumatologists and 29 (37.7%) were nephrologists. 69% of the nephrologists but only 27% of rheumatologists reported having a formal departmental protocol for treating patients with LN (p < 0.001). The first-choice treatment of class IV LN in pre-menopausal female patients differed significantly between nephrologists and rheumatologists (p = 0.026) (see Table 1). For patients who failed to improve on first-line therapy there was no significant difference between nephrologists' and rheumatologists' second-choice therapy (p = 0.50) (see Table 1). However, 55% of nephrologists chose to change to second-choice treatment 3-6 months from the start of first treatment and 34.5% would change after 6-12 months but 81.3% of rheumatologists chose to change after 3-6 months and 10.4% would change in less than 3 months (p = 0.016). For class V LN, MMF was the preferred initial treatment irrespective of whether proteinuria was in nephrotic range or not. For nephrotic range class V LN not responding to first-choice treatment there were significant differences between nephrologists' and rheumatologists' choices for second-line therapy (p = 0.041) (see Table 1). Conclusion There is variation in treatment choices for LN between physicians with different choices reported by nephrologists and rheumatologists. These results suggest that: (i) care may not be well coordinated between rheumatologists and nephrologists; (ii) clearer guidelines are required to ensure use of the best therapies; (iii) access to the most effective therapies needs to be improved. Disclosure S.T. Ibrahim: None. B. Rhodes: None. B. Griffiths: None. C. Gordon: None. C.J. Edwards: None. D. Jayne: None. E.M. Vital: None. L. Lightstone: None. M.R. Ehrenstein: None. P. Hewins: None. Z. Mclaren: None. J.A. Reynolds: None.