Background/Purpose: Patient satisfaction with disease control is an important component of overall health and well-being. Current treatment options for systemic lupus erythematosus (SLE) ±lupus nephritis (LN) include antimalarials, glucocorticoids, and immune modulators, but unmet treatment needs remain. The objectives of this analysis were to evaluate (1) patient and physician satisfaction with treatment–mediated disease control and (2) degree of physician–patient agreement with respect to treatment satisfaction.

Methods: Data were extracted from the Adelphi Real World Lupus Disease–Specific Programme^®, a cross–sectional US survey of 50 rheumatologists, 25 nephrologists, and their consulting patients, conducted December 2009–May 2010. Each physician completed a comprehensive form regarding his or her 5 most recent lupus patients (N=375); data collected included disease severity, treatment history, and current therapy(ies). Physician– and patient–reported satisfaction with the level of disease control was assessed using a 3–point scale.

Results: Physician–reported data were obtained regarding 168 patients with non–nephritis SLE (NNSLE), 164 of whom were treated by rheumatologists, and 206 LN–patients, 120 of whom were treated by nephrologists; patient–reported data were obtained from 212 of these patients (NNSLE, 99; LN, 113). Physicians were satisfied with disease control in 79% (132/168) of NNSLE–patients; 76% (75/99) of NNSLE–patients were satisfied. However, agreement (71%) on the level of satisfaction with disease control among NNSLE–patients and their rheumatologists was “slight” (kappa=.1445). Notably, agreement on the level of satisfaction with disease control declined significantly with NNSLE severity (p=.0062); the greatest agreement was observed for mild NNSLE (59/75; 79%), with less agreement for moderate NNSLE (9/21; 43%) or severe NNSLE (2/3; 67%). As the number of drugs taken by NNSLE–patients increased, agreement on the level of satisfaction decreased (nonsignificant trend, p=.2035): 1 drug, 22/27 (81%); 2 drugs, 22/30 (73%); ≥3 drugs, 26/42 (62%).

Physicians were satisfied with disease control in 74% (152/206) of LN–patients; 65% (74/113) of LN–patients were satisfied. Agreement (71%) on the level of satisfaction among LN–patients (112) and their nephrologists was “fair” (kappa=.3695). Agreement tended to be higher (nonsignificant trend [p=.0740]) in patients with mild (42/56; 75%) or moderate LN (31/41; 76%), compared with severe LN (7/15; 47%). As the number of drugs taken by LN–patients increased, agreement on the level of satisfaction decreased (nonsignificant trend, p=.0764): 1 drug, 17/20 (85%); 2 drugs, 30/39 (77%); ≥3 drugs, 31/51 (61%).

Conclusion: For NNSLE, 21% of rheumatologists and 24% of patients were not satisfied with the level of disease control. For LN, 26% of nephrologists and 35% of patients were not satisfied with the level of disease control. Patients with more severe disease and those taking a higher number of anti–lupus drugs were less likely to agree with their physicians’ level of satisfaction. These disease–control disparities highlight the need for more effective treatment options for both NNSLE and LN.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-survey-of-physician-and-patient-satisfaction-with-control-of-systemic-lupus-erythematosus-and-lupus-nephritis/