Global disparities in the treatment of idiopathic inflammatory myopathies: results from an international online survey study
Articolo
Data di Pubblicazione:
In Stampa
Abstract:
Objectives: We aimed to explore current practice and interregional differences in the treatment of idiopathic inflammatory myopathies (IIMs). We triangulated these observations considering countries' Gross National Income (GNI), disease subtypes, and symptoms using patient-reported information.
Methods: A cross-sectional ancillary analysis of the "COVID-19 vaccination in auto-immune disease" (COVAD) e-survey containing demographic characteristics, IIM subtypes (dermatomyositis (DM), polymyositis (PM), inclusion-body myositis (IBM), anti-synthetase syndrome (ASSD), immune-mediated necrotizing myopathy (IMNM), overlap myopathies (OM)), current symptoms (surrogate for organ involvement), and treatments (corticosteroids (CS), immunomodulators (IM), i.e., antimalarials, immunosuppressants (IS), intravenous immunoglobulins (IVIG), biological treatments, and targeted-synthetic small molecules). Treatments were presented descriptively according to continents, GNI, IIM, and organ involvement, and associated factors were analyzed using multivariable binary logistic regressions.
Results: Of 18,851 respondents from 94 countries, 1,418 with IIM were analyzed (age 61 years, 62.5% females). DM (32.4%), IBM (24.5%), and OM (15.8%) were the most common subtypes. Treatment categories included IS (49.4%), CS (38.5%), IM (13.8%), and IVIG (9.4%). Notably, treatments varied across regions, GNI categories (IS mostly used in higher-middle income, IM in lower-middle income, IVIG and biologics largely limited to high-income countries), IIM subtypes (IS and CS associated with ASSD, IM with OM and DM, IVIG with IMNM, and biological treatments with OM and ASSD) and disease manifestations (IS and CS with dyspnea). Most inter-regional treatment disparities persisted after multivariable analysis.
Conclusion: We identified marked regional treatment disparities in a global cohort of IIM. These observations highlight the need for international consensus-driven management guidelines considering patient-centered care and available resources.
Methods: A cross-sectional ancillary analysis of the "COVID-19 vaccination in auto-immune disease" (COVAD) e-survey containing demographic characteristics, IIM subtypes (dermatomyositis (DM), polymyositis (PM), inclusion-body myositis (IBM), anti-synthetase syndrome (ASSD), immune-mediated necrotizing myopathy (IMNM), overlap myopathies (OM)), current symptoms (surrogate for organ involvement), and treatments (corticosteroids (CS), immunomodulators (IM), i.e., antimalarials, immunosuppressants (IS), intravenous immunoglobulins (IVIG), biological treatments, and targeted-synthetic small molecules). Treatments were presented descriptively according to continents, GNI, IIM, and organ involvement, and associated factors were analyzed using multivariable binary logistic regressions.
Results: Of 18,851 respondents from 94 countries, 1,418 with IIM were analyzed (age 61 years, 62.5% females). DM (32.4%), IBM (24.5%), and OM (15.8%) were the most common subtypes. Treatment categories included IS (49.4%), CS (38.5%), IM (13.8%), and IVIG (9.4%). Notably, treatments varied across regions, GNI categories (IS mostly used in higher-middle income, IM in lower-middle income, IVIG and biologics largely limited to high-income countries), IIM subtypes (IS and CS associated with ASSD, IM with OM and DM, IVIG with IMNM, and biological treatments with OM and ASSD) and disease manifestations (IS and CS with dyspnea). Most inter-regional treatment disparities persisted after multivariable analysis.
Conclusion: We identified marked regional treatment disparities in a global cohort of IIM. These observations highlight the need for international consensus-driven management guidelines considering patient-centered care and available resources.
Tipologia CRIS:
1.1 Articolo in rivista
Keywords:
Keywords: Equity; equity; inflammatory myopathies; myositis; rheumatic disease; survey; treatment.
Elenco autori:
Ziade, Nelly; Aoude, Marc; Hmamouchi, Ihsane; R, Naveen; B Lilleker, James; Sen, Parikshit; Joshi, Mrudula; Agarwal, Vishwesh; Kardes, Sinan; Day, Jessica; Makol, Ashima; Milchert, Marcin; Gheita, Tamer; Salim, Babur; Velikova, Tsvetelina; Edgar Gracia-Ramos, Abraham; Parodis, Ioannis; Nikiphorou, Elena; Chatterjee, Tulika; Lyn Tan, Ai; A Saavedra, Miguel; Katsuyuki Shinjo, Samuel; Knitza, Johannes; Kuwana, Masataka; Nune, Arvind; Cavagna, Lorenzo; Distler, Oliver; Chinoy, Hector; Agarwal, Vikas; Aggarwal, Rohit; Gupta, Latika; the COVAD Study Group Authors: Bhupen Barman, And; Preet Singh, Yogesh; Ranjan, Rajiv; Jain, Avinash; C Pandya, Sapan; Kumar Pilania, Rakesh; Sharma, Aman; M, Manesh Manoj; Gupta, Vikas; G Kavadichanda, Chengappa; Sekhar Patro, Pradeepta; Ajmani, Sajal; Phatak, Sanat; Prosad Goswami, Rudra; Chandra Chowdhury, Abhra; Jacob Mathew, Ashish; Shenoy, Padnamabha; Asranna, Ajay; Talari Bommakanti, Keerthi; Shukla, Anuj; R Pande, Arunkumar; Chandwar, Kunal; Üsküdar Cansu, Döndü; D Pauling, John; Wincup Nicoletta Del Papa, Chris; Sambataro, Gianluca; Fabiola, Atzeni; Govoni, Marcello; Parisi, Simone; Bartoloni Bocci, Elena; Domenico Sebastiani, Gian; Fusaro, Enrico; Sebastiani, Marco; Quartuccio, Luca; Franceschini, Franco; Paolo Sainaghi, Pier; Orsolini, Giovanni; De Angelis, Rossella; Giovanna Danielli, Maria; Venerito, Vincenzo; S Traboco, Lisa; Anggoro Kusumo Wibowo, Suryo; Adrian Zamora Tehozol, Erick; Rojas Serrano, Jorge; García-De La Torre, Ignacio; Loarce-Martos, Jesús; Prieto-González, Sergio; Aranega Gonzalez, Raquel; Yoshida, Akira; Nakashima, Ran; Sato, Shinji; Kimura, Naoki; Kaneko, Yuko; Tomaras, Stylianos; Aleksandrovna Gromova, Margarita; Aharonov, Or; Santos Hoff, Leonardo; Giannini, Margherita; Maurier, François; Campagne, Julien; Meyer, Alain; Nagy-Vincze, Melinda; Langguth, Daman; Limaye, Vidya; Needham, Merrilee; Srivastav, Nilesh; Hudson, Marie; Landon-Cardinal, Océane; Sazliyana Shaharir, Syahrul; Gerardo Rojas Zuleta, Wilmer; António Pereira Silva, José; Eurico Fonseca, João; Zimba., Olena
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