Global disparities in the treatment of idiopathic inflammatory myopathies : results from an international online survey study
Ziade, Nelly Aoude, Marc Hmamouchi, Ihsane Naveen, R Lilleker, James B Sen, Parikshit Joshi, Mrudula Agarwal, Vishwesh Kardes, Sinan Day, Jessica
Ziade, Nelly
Aoude, Marc
Hmamouchi, Ihsane
Naveen, R
Lilleker, James B
Sen, Parikshit
Joshi, Mrudula
Agarwal, Vishwesh
Kardes, Sinan
Day, Jessica
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Affiliation
Saint-Joseph University; Hotel-Dieu de France Hospital; International University of Rabat (UIR); Sandwell and West Birmingham NHS Trust; et al.
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Publication date
2023-05-25
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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.
Citation
Ziade N, Aoude M, Hmamouchi I, Naveen R, Lilleker JB, Sen P, Joshi M, Agarwal V, Kardes S, Day J, Makol A, Milchert M, Gheita T, Salim B, Velikova T, Edgar Gracia-Ramos A, Parodis I, Nikiphorou E, Chatterjee T, Tan AL, Saavedra MA, Shinjo SK, Knitza J, Kuwana M, Nune A, Cavagna L, Distler O, Chinoy H, Agarwal V, Aggarwal R, Gupta L; and the COVAD study group. Global disparities in the treatment of idiopathic inflammatory myopathies: results from an international online survey study. Rheumatology (Oxford). 2023 May 25:kead250. doi: 10.1093/rheumatology/kead250
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Article