Journal Article

Advancing treat-to-target in SLE: a pilot study using a clinical decision support system

Voskuyl, Alexandre, Vos, Koen, van Hall, Odile, van Vollenhoven, Ronald F, Parra Sánchez, Agner R, Tsang-A-Sjoe, Michel, Bultink, Irene E M

2025

Overview

ObjectiveTo evaluate the feasibility, usability and acceptability of implementing a treat-to-target (T2T) strategy supported by a Clinical Decision Support System (CDSS), in routine SLE outpatient care.MethodsA 24-week, non-randomised, multicentre, clustered pilot study was conducted across four rheumatology outpatient centres. Adult patients with SLE were allocated by centre to either a T2T strategy supported by a CDSS (T2T-CDSS) or a routine outpatient care (ROC) group. The CDSS provided evidence-based treatment recommendations based on disease activity measures. Feasibility outcomes included recruitment and retention rates. Usability was assessed with the System Usability Scale (SUS), completed by physicians in the T2T-CDSS group. Acceptability was evaluated using the Treatment Satisfaction Questionnaire (TSQ) and qualitative feedback. Exploratory outcomes included disease activity, remission rates and treatment modifications.ResultsOf 91 screened patients, 38 were enrolled (recruitment rate 42%) and 35 completed the study (retention rate 92%). The SUS score for the CDSS was 73.8, indicating good usability. Global satisfaction scores on the TSQ were stable over time and comparable between groups. Remission was achieved at least once by 61% (11/18) of patients in the T2T-CDSS group and 59% (10/17) in the ROC group. Both treatment intensifications and de-escalations occurred more frequently in the T2T-CDSS group compared with ROC (83% vs 47%). Treatment intensifications were observed in 61% of patients in the T2T-CDSS group vs 29% in the ROC group. Treatment de-escalation, represented by glucocorticoid tapering, occurred in 39% of T2T-CDSS patients compared with 18% in ROC. No statistically significant differences were observed between groups in disease activity outcomes or remission rates.ConclusionsImplementation of a T2T strategy supported by a CDSS in SLE outpatient care was feasible, usable and acceptable to patients and physicians. Although qualitative feedback revealed important implementation barriers that should be addressed in future trials, the intervention facilitated proactive, target-driven treatment adjustments without compromising patient satisfaction and shows promise for implementing goal-directed therapy in SLE management.

• Publisher: Lupus Foundation of America,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Algorithms / Ambulatory care / Ambulatory Care - methods / Clinical decision making / Clinical medicine / Decision support systems / Decision Support Systems, Clinical / Disease control / Epidemiology and Outcomes / Feasibility Studies / Female / Health-Related Quality Of Life / Humans / Intervention / Lupus Erythematosus, Systemic / Lupus Erythematosus, Systemic - drug therapy / Lupus Erythematosus, Systemic - therapy / Male / Middle Aged / Original Research / Outcome Assessment, Health Care / Outpatient care facilities / Patient Satisfaction / Physicians / Pilot Projects / Remission (Medicine) / Remission Induction / Rheumatology / Shared decision making / Surveys and Questionnaires / Task forces / Therapeutics / Treatment Outcome / Usability