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Smith EMD, Gorst SL, Al-Abadi E, et al. 'It is good to have a target in mind': qualitative views of patients and parents informing a treat to target clinical trial in juvenile-onset systemic lupus erythematosus. Rheumatology (Oxford). 2021;60(12):5630-5641doi: 10.1093/rheumatology/keab173.
Smith, E. M. D., Gorst, S. L., Al-Abadi, E., Hawley, D. P., Leone, V., Pilkington, C., Ramanan, A. V., Rangaraj, S., Sridhar, A., Beresford, M. W., & Young, B. (2021). 'It is good to have a target in mind': qualitative views of patients and parents informing a treat to target clinical trial in juvenile-onset systemic lupus erythematosus. Rheumatology (Oxford, England), 60(12), 5630-5641. https://doi.org/10.1093/rheumatology/keab173
Smith, Eve M D, et al. "'It is good to have a target in mind': qualitative views of patients and parents informing a treat to target clinical trial in juvenile-onset systemic lupus erythematosus." Rheumatology (Oxford, England) vol. 60,12 (2021): 5630-5641. doi: https://doi.org/10.1093/rheumatology/keab173
Smith EMD, Gorst SL, Al-Abadi E, Hawley DP, Leone V, Pilkington C, Ramanan AV, Rangaraj S, Sridhar A, Beresford MW, Young B. 'It is good to have a target in mind': qualitative views of patients and parents informing a treat to target clinical trial in juvenile-onset systemic lupus erythematosus. Rheumatology (Oxford). 2021 Dec 01;60(12):5630-5641. doi: 10.1093/rheumatology/keab173. PMID: 33629109; PMCID: PMC8645274.
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Rheumatology (Oxford). 2021 Dec 01;60(12):5630-5641. doi: 10.1093/rheumatology/keab173.

'It is good to have a target in mind': qualitative views of patients and parents informing a treat to target clinical trial in juvenile-onset systemic lupus erythematosus.

Rheumatology (Oxford, England)

Eve M D Smith, Sarah L Gorst, Eslam Al-Abadi, Daniel P Hawley, Valentina Leone, Clarissa Pilkington, Athimalaipet V Ramanan, Satyapal Rangaraj, Arani Sridhar, Michael W Beresford, Bridget Young

Affiliations

  1. Institute of Life Course and Medical Science, University of Liverpool.
  2. Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust.
  3. Department of Health Data Science, University of Liverpool, Liverpool.
  4. Department of Rheumatology, Birmingham Children's Hospital, Birmingham.
  5. Department of Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield.
  6. Department of Paediatric Rheumatology, Leeds General Infirmary, Leeds.
  7. Department of Paediatric Rheumatology, Great Ormond Street Hospital, London.
  8. Bristol Royal Hospital for Children & Translational Health Sciences, University of Bristol, Bristol.
  9. Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham.
  10. Leicester Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester.
  11. Institute of Population Health, University of Liverpool, Liverpool, UK.

PMID: 33629109 PMCID: PMC8645274 DOI: 10.1093/rheumatology/keab173

Abstract

OBJECTIVE: We sought to explore patient and parental views on treatment targets, outcome measures and study designs being considered for a future JSLE treat-to-target (T2T) study.

METHODS: We conducted topic-guided, semistructured interviews with JSLE patients and parents and analysed the audio recorded interviews using thematic approaches.

RESULTS: Patients and parents differed regarding symptoms they felt would be tolerable, representing 'low disease activity'. Patients often classed symptoms that they had previously experienced, were 'invisible' or had minimal disruption on their life as signs of low disease activity. Parents were more accepting of visible signs but were concerned about potential organ involvement and symptom severity. Overall, patients and parents preferred that children were entirely asymptomatic, with no ongoing treatment side effects. They regarded fatigue as particularly challenging, requiring proper monitoring using a fatigue patient-reported outcome measure. Most families felt that reducing corticosteroids would also be a good treatment target. Overall, families liked the concept of T2T, commenting that it could help to improve disease control, help structure treatment and improve communication with clinicians and treatment compliance. They were concerned that T2T might increase the frequency of hospital visits, thus impacting upon schooling, parental employment and finances. Families made suggestions on how to modify the future trial design to mitigate such effects.

CONCLUSION: This study provides guidance from patients and parents on T2T targets and study designs. Complementary quantitative studies assessing the achievability and impact of different targets (e.g. lupus low disease activity state or remission) are now warranted to inform an international consensus process to develop treatment targets.

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Keywords: juvenile-onset systemic lupus erythematosus; patient perspectives; qualitative; treat to target

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