First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)

Bernardo A. Pons-Estel, Eloisa Bonfa, Enrique R. Soriano, Mario H. Cardiel, Ariel Izcovich, Federico Popoff, Juan M. Criniti, Gloria Vásquez, Loreto Massardo, Margarita Duarte, Leonor A. Barile-Fabris, Mercedes A. García, Mary Carmen Amigo, Graciela Espada, Luis J. Catoggio, Emilia Inoue Sato, Roger A. Levy, Eduardo M. Acevedo Vásquez, Rosa Chacón-DÍaz, Claudio M. Galarza-MaldonadoAntonio J. Iglesias Gamarra, José Fernando Molina, Oscar Neira, Clóvis A. Silva, Andrea Vargas Peña, José A. Gómez-Puerta, Marina Scolnik, Guillermo J. Pons-Estel, Michelle R. Ugolini-Lopes, Verónica Savio, Cristina Drenkard, Alejandro J. Alvarellos, Manuel F. Ugarte-Gil, Alejandra Babini, André Cavalcanti, Fernanda Athayde Cardoso Linhares, Maria Jezabel Haye Salinas, Yurilis J. Fuentes-Silva, Ana Carolina Montandon De Oliveira E Silva, Ruth M. Eraso Garnica, Sebastián Herrera Uribe, DIana Gómez-Martín, Ricardo Robaina Sevrini, Rosana M. Quintana, Sergio Gordon, Hilda Fragoso-Loyo, Violeta Rosario, Verónica Saurit, Simone Appenzeller, Edgard Torres Dos Reis Neto, Jorge Cieza, Luis A. González Naranjo, Yelitza C. González Bello, María Victoria Collado, Judith Sarano, Soledad Retamozo, María E. Sattler, Rocio V. Gamboa-Cárdenas, Ernesto Cairoli, Silvana M. Conti, Luis M. Amezcua-Guerra, Luis H. Silveira, Eduardo F. Borba, Mariana A. Pera, Paula B. Alba Moreyra, Valeria Arturi, Guillermo A. Berbotto, Cristian Gerling, Carla A. Gobbi, Viviana L. Gervasoni, Hugo R. Scherbarth, João C.Tavares Brenol, Fernando Cavalcanti, Lilian T.Lavras Costallat, Nilzio A. Da Silva, Odirlei A. Monticielo, Luciana Parente Costa Seguro, Ricardo M. Xavier, Carolina Llanos, Rubén A. Montúfar Guardado, Ignacio Garcia De La Torre, Carlos Pineda, Margarita Portela Hernández, Alvaro Danza, Marlene Guibert-Toledano, Gil Llerena Reyes, Maria Isabel Acosta Colman, Alicia M. Aquino, Claudia S. Mora-Trujillo, Roberto Muñoz-Louis, Ignacio García Valladares, María Celeste Orozco, Paula I. Burgos, Graciela V. Betancur, Graciela S. Alarcón

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Abstract

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.

Original languageEnglish
Pages (from-to)1549-1557
Number of pages9
JournalAnnals of the Rheumatic Diseases
Volume77
Issue number11
DOIs
StatePublished - 1 Nov 2018

Bibliographical note

Funding Information:
Competing interests LBF, BAPE and OAM have been speakers for GlaxoSmithKline (GSK). JCTB has received research grants from GSK. RMX, ON and JFM have received support grants for meetings from GSK. JAGP has been a lecturer for Roche. ERS has received research grants and has been a lecturer for Roche. JFM has been a clinical researcher for Anthera. MHC has received research grants from Roche and is an advisor for Eli Lilly.

Publisher Copyright:
© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

  • lupus nephritis
  • systemic lupus erythematosus
  • treatment

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