Effectiveness of a multidisciplinary clinical pathway for women with systemic lupus erythematosus and/or antiphospholipid syndrome. Issue 1 (5th May 2021)

• Record Type: Journal Article
• Authors: Wind, Merlijn; Hendriks, Maike; van Brussel, Bernadette T J; Eikenboom, Jeroen; Allaart, Cornelia F; Lamb, Hildo J; Siebelink, Hans-Marc J; Ninaber, Maarten K; van Geloven, Nan; van Lith, Jan M M; Huizinga, Tom W J; Rabelink, Ton J; Sueters, Marieke; Teng, Y K Onno
• Is Part Of: Lupus science & medicine. Volume 8:Issue 1(2021)
• Publication Date: 2021-05-05
• Subjects: systemic lupus erythematosus -- lupus nephritis -- antiphospholipid syndrome; Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1136/lupus-2020-000472
• Languages: English
• ISSNs: 2398-8851

Abstract

Abstract : Objectives: SLE and/or antiphospholipid syndrome (SLE/APS) are complex and rare systemic autoimmune diseases that predominantly affect women of childbearing age. Women with SLE/APS are at high risk of developing complications during pregnancy. Therefore, clinical practice guidelines recommend that patients with SLE/APS should receive multidisciplinary counselling before getting pregnant. We investigated the clinical effectiveness of implementing a multidisciplinary clinical pathway including prepregnancy counselling of patients with SLE/APS. Methods: A clinical pathway with specific evaluation and prepregnancy counselling for patients with SLE/APS was developed and implemented in a tertiary, academic hospital setting. Patients were prospectively managed within the clinical pathway from 2014 onwards and compared with a retrospective cohort of patients that was not managed in a clinical pathway. Primary outcome was a combined outcome of disease flares for SLE and thromboembolic events for APS. Secondary outcomes were maternal and fetal pregnancy complications. Results: Seventy-eight patients with 112 pregnancies were included in this study. The primary combined outcome was significantly lower in the pathway cohort (adjusted OR (aOR) 0.20 (95% CI 0.06 to 0.75)) which was predominantly determined by a fivefold risk reduction of SLE flares (aOR 0.22 (95% CI 0.04 to 1.09)). Maternal and fetal pregnancy complications were not different between the cohorts (respectively, aOR 0.91 (95% CI 0.38 to 2.17) and aOR 1.26 (95% CI 0.55 to 2.88)). Conclusions: The outcomes of this study suggest that patients with SLE/APS with a pregnancy wish benefit from a multidisciplinary clinical pathway including prepregnancy counselling.