Authors (including presenting author) :
So H(1)(2), Chow E(1), Cheng IT(1), Lau SL(1), Li TK(1), Szeto CC(1)(2), Tam LS(1)(2)
Affiliation :
1. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
2. Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Introduction :
Patients with lupus nephritis (LN) might be more susceptible to Covid-19 due to the underlying disease, co-morbidities and use of immunosuppressants. We hypothesized that telemedicine (TM) can be an effective mode of health-care delivery minimizing the risk of infection exposure, while maintaining disease control in these patients.
Objectives :
The primary aim of this study was to evaluate the effectiveness to achieve lupus low disease activity state (LLDAS) using TM delivered care compared to conventional follow-up in LN. The secondary objectives were to compare the patient satisfaction and Covid-19 infection risk.
Methodology :
This was a single-center randomized controlled study. Consecutive patients followed at the LN clinic were randomized to either TM (TM group) or standard care (SC group) in a 1:1 ratio. Patients in the TM group received scheduled follow-ups (FU) via videoconferencing. SC group patients continued conventional in-person outpatient care. Achievement of LLDAS, patient satisfaction and Covid-19 infection risk were compared.
Result & Outcome :
From 15/5-14/12/2020, 122 patients were randomized (TM: 60, SC: 62) and had attended at least 2 FU visits. The mean age of the patients was 44.4±11.5 years. The mean disease duration was 15.1±9.0 years. Almost all patients had biopsy proven LN class III, IV or V (94.7%) and were on prednisolone (91.8%), and the majority (73.8%) were on immunosuppressants. There were no differences, including SLEDAI-2k and proportion of patients in LLDAS, between the 2 groups at baseline except a higher physician global assessment score (PGA) in the TM group (mean 0.67±0.69 vs 0.45±0.60, p=0.003). After a mean FU of 19.8±4.5 weeks, the proportions of patients remained in LLDAS were similar in the 2 groups (TM: 75.0% vs SC: 74.2%, p=0.919). Although the PGA was still higher in the TM group (0.52±0.49 vs 0.36±0.40, p=0.025), there was no difference in the SLEDAI-2k between the 2 groups. The within-group changes and between-group difference of change in PGA were also not significant. The overall satisfaction (1-5, 5=highest) was higher in the TM group (mean 3.19 vs 2.89, p=0.042). The mean waiting time before consultation was shorter in the TM group (mean 22.5±28.6 vs 68.9±40.7 mins, p< 0.001). There was a trend suggesting that alternative mode of follow-up was required more frequently by patients from the TM group than the SC group (TM: 12/60, 20.0% and SC: 5/62, 8.1%; p=0.057). More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%; p=0.049) within the study period which was no longer statistically significant after adjusting for the baseline PGA. None of the patients had Covid-19. To conclude, TM follow-up appeared to be equally efficacious in maintaining the disease activity of patients with LN and have better patient satisfaction when compared to standard care.
