USE OF TELEMEDICINE FOR FOLLOW-UP OF SLE PATIENTS WITH NEPHRITIS IN THE COVID-19 OUTBREAK (“TeleSLE”): THE 6-MONTH RESULTS OF A RANDOMIZED CONTROLLED TRIAL

ABSTRACT

Background: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) could be a well-accepted mode of health-care delivery minimizing the risk of exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while maintaining disease control in these patients.Objectives:To evaluate the short-term patient satisfaction, compliance, disease control and infection risk of TM compared with standard in-person follow-up (FU) for patients with LN during COVID-19.Methods:This was a single-center randomized-controlled study. Consecutive patients followed at the LN clinic were randomized to either TM (TM group) or standard FU (SF group) in a 11 ratio. Patients in the TM group received scheduled follow-ups via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared.Results:From June to December 2020, 122 patients were randomized (TM 60, SF 62) and had attended at least 2 FU visits. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the 2 groups 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) (Table 1). The mean FU duration was 19.8±4.5 weeks. When comparing the most recent visit, the mean waiting time between entering the clinic waiting room (virtual or real) and seeing a rheumatologist (virtual or in-person) was significantly shorter in the TM group (22.5±28.6 vs 68.9±40.7 minutes, p< 0.001) (Figure 1A). The mean overall patient satisfaction score was higher in the TM group (mean 2.19±0.61 vs 1.89±0.78, p=0.042). The results of the post-consultation satisfaction questionnaire are shown in Figure 1B. The number of visits was similar in the two groups (TM 3.1±1.3 vs SF 3.0±1.2, p=0.981). However, there was a trend suggesting that alternative mode of FU was requested more frequently in the TM group than the SF group (TM 12/60, 20.0% and SF 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 FU period, which was no longer statistically significant after adjusting for the baseline PGA. The proportions of patients remained in LLDAS were similar in the 2 groups (TM 75.0% vs SF 74.2%, p=0.919). None of the patients had COVID-19.Conclusion:TM resulted in better patient satisfaction and could achieve similar disease control in patients with LN in the short-term when compared to standard care.Table 1.Baseline clinical data of the recruited patients and comparison between the telemedicine/standard follow-up groupsOverall (n=122)Telemedicine group (n=60)Standard follow-up group (n=62)P-valueAge in years44.4±11.544.1±11.744.7±11.50.779Gender Female111 (91.0)55 (91.7)56 (90.3)0.796Disease duration in years15.1±9.016.2±8.714.0±9.10.115Nephritis class III, IV or V108 (88.5)54 (90.0)54 (87.1)0.42724 hour urine proteinuria in gram0.51±0.630.53±0.600.50±0.650.712Current use of prednisolone112 (91.8)57 (95.0)55 (88.7)0.323Daily prednisolone dose in mg5.51±4.215.69±4.175.34±4.290.570Use of immunosuppressant90 (73.8)46 (76.7)44 (71.0)0.474SLEDAI-2K3.65±2.334.00±2.343.30±2.290.097PGA0.56±0.650.67±0.690.45±0.600.003LLDAS78 (63.9)36 (60.0)42(67.7)0.251Remission0 (0)0 (0)0 (0)n/aPresence of comorbidity87 (71.3)40 (66.7)47 (75.8)0.264SDI0.93±1.151.08±1.280.78±0.980.243HAQ-DI0.23±0.460.25±0.470.21±0.440.571HADS Anxiety scale Depression scale6.07±4.12 5.72±4.316.20±4.19 5.73±3.935.93±4.09 5.70±4.680.720 0.724Data are reported as mean ± SD or number (%). LLDAS lupus low disease activity state;SDI Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index;HAQ-DI Health Assessment Questionnaire Disability Index;and HADS Hospital Anxiety and Depression Scale.Disclosure of InterestsHo SO None declared, Evelyn Chow None declared, Tena K. Li None declared, Sze-Lok Lau None declared, Isaac T. Cheng None declared, Cheuk-Chun Szeto None declared, Lai-Shan Tam Grant/research support from Grants from Novartis and Pfizer.