POS1164 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
Authors: H. So, E. Chow, T. K. LI, S. L. Lau, I. T. Cheng, C. C. Szeto, L. S. Tam
Journal: Annals of the Rheumatic Diseases (2021)

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 1:1 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&lt; 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 groups Overall (n=122) Telemedicine group (n=60) Standard follow-up group (n=62) P-value Age in years 44.4±11.5 44.1±11.7 44.7±11.5 0.779 Gender: Female 111 (91.0) 55 (91.7) 56 (90.3) 0.796 Disease duration in years 15.1±9.0 16.2±8.7 14.0±9.1 0.115 Nephritis class III, IV or V 108 (88.5) 54 (90.0) 54 (87.1) 0.427 24 hour urine proteinuria in gram 0.51±0.63 0.53±0.60 0.50±0.65 0.712 Current use of prednisolone 112 (91.8) 57 (95.0) 55 (88.7) 0.323 Daily prednisolone dose in mg 5.51±4.21 5.69±4.17 5.34±4.29 0.570 Use of immunosuppressant 90 (73.8) 46 (76.7) 44 (71.0) 0.474 SLEDAI-2K 3.65±2.33 4.00±2.34 3.30±2.29 0.097 PGA 0.56±0.65 0.67±0.69 0.45±0.60 0.003 LLDAS 78 (63.9) 36 (60.0) 42(67.7) 0.251 Remission 0 (0) 0 (0) 0 (0) n/a Presence of comorbidity 87 (71.3) 40 (66.7) 47 (75.8) 0.264 SDI 0.93±1.15 1.08±1.28 0.78±0.98 0.243 HAQ-DI 0.23±0.46 0.25±0.47 0.21±0.44 0.571 HADS: Anxiety scale Depression scale 6.07±4.12 5.72±4.31 6.20±4.19 5.73±3.93 5.93±4.09 5.70±4.68 0.720 0.724 Data 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 Interests: Ho 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.