A Multicriteria Decision Analysis for the Development of New Systemic Lupus Erythematosus Classification Criteria

Sara K. Tedeschi¹, Sindhu Johnson², Dimitrios Boumpas³, David I. Daikh⁴, Betty Diamond⁵, Thomas Doerner⁶, Søren Jacobsen⁷, Diane L. Kamen⁸, W. Joseph McCune⁹, Marta Mosca¹⁰, Rosalind Ramsey-Goldman¹¹, Guillermo Ruiz-Irastorza¹², Matthias Schneider¹³, Josef S. Smolen¹⁴, Murray Urowitz¹⁵, David Wofsy¹⁶, Martin Aringer¹⁷, Raymond P. Naden¹⁸ and Karen H. Costenbader^19,20, ¹Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, ²Rheumatology, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada, ³University of Athens, Athens, Greece, ⁴Rheumatology, UCSF/VA Medical Center, San Francisco, CA, ⁵Feinstein Institute for Medical Research, Manhasset, NY, ⁶Charité Universitätmedizin Berlin and DRFZ, Berlin, Germany, ⁷Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, ⁸Medicine/Rheumatology & Immunology, Medical University of South Carolina, Charleston, SC, ⁹Int Med/ Rheum, University of Michigan, Ann Arbor, MI, ¹⁰Rheumatology Unit, University of Pisa, Pisa, Italy, ¹¹FSM, Northwestern University, Chicago, IL, ¹²Autoimmune Diseases Research Unit, BioCruces, Hospital Universitario Cruces, Baracaldo, Spain, ¹³Policlinic for Rheumatology & Hiller Research Centre for Rheumatology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany, ¹⁴Division of Rheumatology, Medical University of Vienna and Hietzing Hospital, Vienna, Austria, ¹⁵Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, ¹⁶Rheumatology, UCSF, San Francisco, CA, ¹⁷Medicine III, University Medical Center and Faculty of Medicine at the TU Dresden, Dresden, Germany, ¹⁸New Zealand Ministry of Health, New Zealand Ministry of Health, Auckland, New Zealand, ¹⁹Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, ²⁰Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: classification criteria, decision analysis and systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 6, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

EULAR and ACR are supporting multi-phase development of SLE classification criteria based on weighted criteria and a continuous probability scale. Prior steps included criteria generation, criteria reduction through Delphi and Nominal Group Technique exercises, literature review for sensitivity/specificity of candidate criteria, and organization of candidate criteria into seven clinical and three immunologic domains. Our next goals were to refine definitions of candidate criteria, determine relative weights using multicriteria decision analysis (MCDA), and identify a threshold score on a continuous scale for SLE classification.

Methods:

An SLE Expert Panel (9 North American, 8 European) submitted 167 unique cases, with range of SLE probability. Experts scored 20 representative cases using the candidate criteria and rank-ordered them. In a two day meeting, experts reviewed inter-rater reliability of scoring, refined criteria definitions, and participated in a MCDA exercise using 1000Minds^TM software. Experts were presented with a series of decisions between two cases, each with different criteria from two domains (e.g. oral ulcers [cutaneous] and acute pericarditis [serositis] vs. alopecia [cutaneous] and pleural effusion [serositis]). Experts anonymously voted for the case more likely to be classified as SLE. Votes were discussed until consensus was reached for each decision. Using the consensus decisions, 1000Minds^TMcalculated criteria weights, assigned a total score to each of remaining 147 cases and rank-ordered the cases. Experts voted on whether each case should be classified as SLE. The score of the last case for which consensus was achieved was the threshold score. Experts repeated the MCDA for criteria whose calculated weights were inconsistent with expert opinion until group consensus was achieved.

Results:

Inter-rater reliability was good; human data entry error, not following instructions, and differing interpretations of criteria definitions accounted for discrepancies. Arthritis and pericarditis definitions were modified through group discussion. The MCDA involved 74 pairwise decisions. Cranial neuropathy and Class VI lupus nephritis were removed as they added little to SLE classification. MCDA was repeated for the arthritis and cutaneous domains as initial weights did not match expert opinion. Criteria weights and scores were re-calculated. Experts reached consensus for SLE classification for case scores >83.

Conclusion:

Using an iterative process, the expert panel refined and weighted candidate criteria definitions and determined a threshold score of >83 for SLE classification. Validation is the next step.

Disclosure: S. K. Tedeschi, None; S. Johnson, None; D. Boumpas, None; D. I. Daikh, None; B. Diamond, None; T. Doerner, None; S. Jacobsen, None; D. L. Kamen, None; W. J. McCune, None; M. Mosca, None; R. Ramsey-Goldman, None; G. Ruiz-Irastorza, None; M. Schneider, None; J. S. Smolen, None; M. Urowitz, None; D. Wofsy, None; M. Aringer, None; R. P. Naden, None; K. H. Costenbader, None.

To cite this abstract in AMA style:

Tedeschi SK, Johnson S, Boumpas D, Daikh DI, Diamond B, Doerner T, Jacobsen S, Kamen DL, McCune WJ, Mosca M, Ramsey-Goldman R, Ruiz-Irastorza G, Schneider M, Smolen JS, Urowitz M, Wofsy D, Aringer M, Naden RP, Costenbader KH. A Multicriteria Decision Analysis for the Development of New Systemic Lupus Erythematosus Classification Criteria [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/a-multicriteria-decision-analysis-for-the-development-of-new-systemic-lupus-erythematosus-classification-criteria/. Accessed .

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