Familiarity with EuroLupus dosing for cSLE remains low despite uptick in use

Paediatric specialists now use low-dose EuroLupus cyclophosphamide (CYC) more than they did a decade ago in the treatment of childhood-onset systemic lupus erythematosus (cSLE), reports a study in North America. However, familiarity with EuroLupus dosing is still low.

“CSLE has higher rates of LN than adult-onset SLE, often requiring intensive immunosuppression,” the researchers said.

Providers from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) and Pediatric Nephrology Research Consortium (PNRC) completed a 35-item web-based survey, which assessed participant demographics, CYC prescribing practices, perceptions of EuroLupus protocol, and lupus nephritis (LN) vignette treatment decisions. One vignette was taken from a 2009 CARRA survey; responses were then compared.

Finally, the researchers performed multivariable logistic regression analysis to assess the association of factors with use of low- vs high-dose CYC.

Overall, 185/421 (44 percent) paediatric rheumatologists (CARRA) and 40/354 (11 percent) paediatric nephrologists (PNRC) responded to the survey. Half of the 135 specialists who prescribed CYC for paediatric LN over the past year reported using EuroLupus.

Thirty-two percent of paediatric rheumatologists chose EuroLupus dosing in 2020, compared with only 6 percent in 2009, when presented with the same vignette about an adolescent with class IV LN. Familiarity with the protocol (odds ratio [OR], 4.2; p=0.006) and greater perceived benefit (OR, 1.6; p<0.0001) were associated with choosing the low-dose regimen. Similar responses were noted among paediatric nephrologists.

Furthermore, majority of the respondents (78 percent) perceived EuroLupus protocol to be as effective as the high-dose protocol in cSLE LN.