FRI0447 Worldwide expert agreement on updated eular/eustar recommendations for the treatment of systemic sclerosis
Authors: J. De Vries-Bouwstra, Y. Allanore, M. Matucci-Cerinic, A. Balbir-Gurman
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In 2017, updated EULAR/EUSTAR recommendations for treatment of Systemic sclerosis (SSc) were published.<sup>1</sup> Implementation in clinical practice of these recommendations might be dependent on agreement and local drug availability. <h3>Objectives</h3> To evaluate worldwide agreement of the updated recommendations for treatment of SSc among SSc experts. To determine factors that might influence agreement. <h3>Methods</h3> An online survey was set out (June – September 2017), containing the 17 EULAR/EUSTAR updated recommendations. Levels of agreement were determined for each item on a 10-point scale (0=not at all; 10=completely agree). Local drug availability was assessed (yes/no). An e-mail containing a web link to the survey was sent out to international SSc-networks (EUSTAR, Scleroderma Clinical Trials Consortium, Australian Scleroderma Interest Groups, International Systemic Sclerosis Inception Cohort) and to 54 additional SSc-experts representing South-America and Asia. Levels of agreement were compared between subgroups stratified for EUSTAR membership, geographical area, drug availability, and years of experience. <h3>Results</h3> In total 269 responders participated, of whom n=209 completed each single item. The majority are rheumatologists (n=200, 83%), currently working in Europe (n=185; 71%); 65% (n=156) are EUSTAR member, and have &gt;10 years of experience in the SSc field (n=150; 63%). Other geographical areas are also represented (Africa n=2, 1%; Asia n=18,7%; Australia n=13,5%; North-America n=27,10%; South-America n=17,6%). Mean level of agreement was high (8.0; standard deviation [SD, 2.5], with top-3 highest mean agreement for ACE-inhibitors for scleroderma renal crisis (9.2 [2.1]), blood pressure control in case of corticosteroids (9.0 [2.2]) and treatment with protonpump inhibitors to prevent reflux complications (9.0 [2.2]). Top 3 of lowest mean agreement included fluoxetine for Raynauds phenomenon (RP) (4.6[ 2.8]), hematopoietic stem cell transplantation (HSCT) for severe SSc (7.1 [2.9]) and methotrexate for skin involvement in early diffuse SSc (7.4[ 2.8]). When comparing Europe to other regions agreement differed significantly (p&lt;0.05) for the following recommendations: iloprost for RP, iloprost and bosentan for digital ulcers, methotrexate for early diffuse SSc, cyclophosphamide for SSc-related lung disease, and HSCT for severe SSc. Comparison of agreement between responders stratified for EUSTAR membership (yes/no), years of clinical experience (&lt;or&gt;10 years) and local availability of the drug/treatment option (yes/no) showed that in case of iloprost, bosentan and HSCT availability of drug/treatment option contributed to differences in agreement. Neither EUSTAR membership nor years of experience could explain these differences. <h3>Conclusions</h3> In general, worldwide agreement on recently updated recommendations for treatment of SSc is high. Differences in agreement are partially explained by geographical area and local drug availability. Future evaluations should focus on implementation of published recommendations and take drug availability into account to further improve guideline-development. <h3>Reference</h3> [1] Ann Rheum Dis. 2017Aug;76(8):1327. <h3>Disclosure of Interest</h3> None declared