Definition and application of systemic lupus erythematosus disease modification in emerging markets: Delphi panel consensus recommendations

Objective To better understand the acceptance and potential application of the systemic lupus erythematosus (SLE) and lupus nephritis (LN) disease modification framework, which was first proposed in 2022, among experts in the Gulf region and Latin America. Methods Two cross-sectional Delphi surveys of a panel of expert SLE physicians were conducted, with a workshop discussion held between the two surveys. Surveys comprised multiple choice and open-response questions. Experts from Argentina, Bahrain, Brazil, Mexico, Oman, Saudi Arabia and United Arab Emirates were selected based on their demonstrated expertise in SLE. Consensus was indicated by >75% agreement among experts in survey responses. Consensus was also evaluated by Gulf and Latin American regions to identify any regional differences. Results There was consensus across all the queried statements on the concept and components of disease modification, with some minor regional differences observed. Experts unanimously agreed that early diagnosis, early referral to a lupus specialist and a multidisciplinary approach are key factors for achieving disease modification and better patient outcomes. Aspects of the published SLE/LN disease modification definition were either ‘routinely’ (31%) or ‘sometimes’ (62%) assessed in current clinical practice. A consensus was reached that biomarkers are a key component of evaluating disease modification (91%), but that currently available biomarkers are sub-optimal (96%). There was consensus that immunosuppressants (96%), biologics (92%) and hydroxychloroquine (88%) are disease modifying treatments. Experts from the Gulf, but not Latin America, agreed that glucocorticoids are not disease modifying. Conclusions There was strong consensus across experts from the Gulf and Latin America that the concept of disease modification can provide a valuable framework to support clinicians for the management of patients with SLE and LN. Experts emphasised that clear guidance is required for clinicians to apply the disease modification framework to their routine practice, and in varying local healthcare systems.