POS1222 FACTORS ASSOCIATED WITH USE OF TELEMEDICINE FOR FOLLOW-UP OF LUPUS NEPHRITIS IN THE COVID-19 OUTBREAK

Abstract

Background:It is important to weigh the potential risk of exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a doctor visits against the risk of missing disease controls in patients with lupus nephritis during the COVID-19. Telemedicine (TM) follow-up is a reasonable option. Despite the recent exponential increase in application worldwide, there is no study examining the clinical factors associated with the patients‘ choice of TM use in lupus nephritis.Objectives:In this study, we aimed to examine the clinical variables associated with a higher preference for TM follow-up in patients with lupus nephritis.Methods:Consecutive patients followed at the lupus nephritis clinic were contacted for their preferred mode of follow-up. The demographic, socioeconomic and clinical data of the first 140 patients opted for TM and 140 patients preferred to continue standard in-person follow-up were collected and compared.Results:The mean age of the 280 recruited patients was 45.6 ± 11.8 years. The mean disease duration was 15.0 ± 9.2 years. The majority of them had lupus nephritis class III, IV or V (88.2%) and were on prednisolone (90%). Three quarters of the patients (67.1%) were on immunosuppressants. The mean SLEDAI-2k was 4.06 ± 2.54, physician global assessment (PGA) 0.46 ± 0.62 and SLICC/ACR damage index 1.11 ± 1.36. A significant proportion of the patients (72.1%) had one or more comorbidities. It was found that patients with higher PGA and family monthly income (> USD3,800) preferred TM, while fulltime employees preferred in-person follow-up (Table 1). These predictors remained significant after controlling for age in the multivariate analysis with odd ratios for PGA 1.05 (95% CI 1.01-1.09), family income >USD3,800 1.90 (95% CI 1.24-3.79) and fulltime employment 0.53 (95% CI 0.32-0.88). PGA was noted to be positively correlated with the perceptions that TM reduces (r=0.13, p=0.036) and routine visit increases (r=0.12, p=0.04) the risk of COVID-19 during the outbreak.Conclusion:When choosing the mode of care delivery between TM and clinic visit, the patient’s disease activity as well as employment and economic status appeared to be important.Table 1.Demographic, socio-economic and disease data of the recruited lupus nephritis patients with comparison between the telemedicine/standard follow-up groupsOverall (n=280)Telemedicine group (n=140)Standard follow-up group (n=140)P-valueAge in years45.6±11.844.6±11.446.6±12.10.159Gender: Female256 (91.4)127 (90.7)129 (92.1)0.669Ever presence of rash170 (60.8)87 (62.1)82 (58.6)0.527Ever presence of joint pain174 (62.1)92 (65.7)82 (58.6)0.247Disease duration in months15.8±9.515.0±9.316.5±9.60.17624 hour urine proteinuria in gram0.45±0.600.50±0.630.40±0.570.176Daily prednisolone dose in mg8.82±6.15.28±4.466.35±7.370.143Use of immunosuppressant188 (67.1)96 (68.6)92 (65.7)0.611SLEDAI-2K3.39±2.353.51±2.283.26±2.410.366PGA0.46±0.620.54±0.630.38±0.590.025LLDAS196 (70)92 (0.66)104 (74.3)0.160Presence of comorbidity202 (72.1)100 (71.4)102 (72.9)0.790SDI0.97±1.230.95±1.211.00±1.260.732HAQ-DI0.20±0.400.23±0.450.18±0.340.300HADS: Anxiety scale5.93±3.985.86±4.066.00±3.910.776 Depression scale5.57±3.915.56±4.255.59±3.540.954Education level: tertiary or above122 (43.6)63 (45.0)59 (42.1)0.746Fulltime employment127 (45.4)56 (40.0)71 (50.7)0.041Occupation: professionals36 (12.9)22 (15.7)14 (10.0)0.181Monthly family income > USD3,80084 (30.0)51 (36.4)33 (23.6)0.028Data are reported as mean ± SD or number (%). HAQ-DI: Health Assessment Questionnaire Disability Index; HADS: Hospital Anxiety and Depression Scale; PGA: physician global assessment; LLDAS: lupus low disease activity state and SDI: Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index.Disclosure of Interests:Ho SO: None declared, Evelyn Chow: None declared, Tena K. Li: None declared, Isaac T. Cheng: None declared, Sze-Lok Lau: None declared, Cheuk-Chun Szeto: None declared, Lai-Shan Tam Grant/research support from: Grants from Novartis and Pfizer