PMID- 33938498
OWN - NLM
STAT- MEDLINE
DCOM- 20211125
LR  - 20230927
IS  - 1536-7355 (Electronic)
IS  - 1076-1608 (Linking)
VI  - 27
IP  - 8
DP  - 2021 Dec 1
TI  - An Initiative to Improve Timely Glucocorticoid Tapering in Vasculitis.
PG  - e612-e615
LID - 10.1097/RHU.0000000000001744 [doi]
AB  - BACKGROUND/OBJECTIVE: High-dose glucocorticoids (GCs) are required in the initial 
      treatment of systemic vasculitis. However, slow or delayed tapering can lead to 
      unnecessary GC exposure and toxicity. In this quality improvement initiative, we 
      aimed to increase appropriate GC tapering among newly referred patients awaiting 
      specialty consultation at a tertiary vasculitis clinic. METHODS: For each patient 
      referred for anti-neutrophil cytoplasm antibody-associated vasculitis (AAV) or 
      large vessel vasculitis (LVV), recommendation-based GC tapering suggestions were 
      faxed to referring physicians. To maximize uptake, the intervention format was 
      modified according to feedback from referring physicians' offices. The proportion 
      of new patients presenting to their first appointment who (1) had started to 
      taper GCs, (2) were taking their target GC dose according to recommendations, (3) 
      experienced a vasculitis flare during tapering were compared before (July 
      2017-January 2019) and after (February-October 2019) the intervention. RESULTS: 
      Among 169 consecutive patients referred for AAV or LVV, the proportion who had 
      started to taper GCs by their first visit increased from 84 of 117 (72%) 
      preintervention to 49 of 52 (94%) postintervention (p < 0.01). Mean daily 
      prednisone dose at first visit decreased from 29.9 (SD, 18) mg to 21.7 (SD, 14) 
      mg (p < 0.01). However, the proportion who were ultimately taking "target" GC 
      doses at their first visit did not significantly increase (72% vs. 77%). Disease 
      flares during tapering were similar before and after the intervention (9% vs. 
      12%). CONCLUSIONS: Patients with AAV and LVV had increased GC tapering and lower 
      GC doses at first visit following a preappointment intervention. Further 
      strategies are needed to improve timely GC tapering in vasculitis.
CI  - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Mendel, Arielle
AU  - Mendel A
AD  - From the Lupus and Vasculitis Clinic, Division of Rheumatology, McGill University 
      Health Centre, Montreal, Quebec.
FAU - Ennis, Daniel
AU  - Ennis D
AD  - Division of Rheumatology, Vancouver General Hospital, Vancouver, British 
      Columbia.
FAU - Lake, Shirley
AU  - Lake S
AD  - Division of Rheumatology, Sunnybrook Health Sciences Centre.
FAU - Carette, Simon
AU  - Carette S
AD  - Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, Toronto, 
      Ontario, Canada.
FAU - Pagnoux, Christian
AU  - Pagnoux C
AD  - Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, Toronto, 
      Ontario, Canada.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Clin Rheumatol
JT  - Journal of clinical rheumatology : practical reports on rheumatic & 
      musculoskeletal diseases
JID - 9518034
RN  - 0 (Glucocorticoids)
RN  - VB0R961HZT (Prednisone)
SB  - IM
MH  - *Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy
MH  - *Arteritis
MH  - Glucocorticoids
MH  - Humans
MH  - Prednisone
MH  - Treatment Outcome
COIS- The authors declare no conflict of interest.
EDAT- 2021/05/04 06:00
MHDA- 2021/11/26 06:00
CRDT- 2021/05/03 09:15
PHST- 2021/05/04 06:00 [pubmed]
PHST- 2021/11/26 06:00 [medline]
PHST- 2021/05/03 09:15 [entrez]
AID - 00124743-202112000-00060 [pii]
AID - 10.1097/RHU.0000000000001744 [doi]
PST - ppublish
SO  - J Clin Rheumatol. 2021 Dec 1;27(8):e612-e615. doi: 10.1097/RHU.0000000000001744.