According to Dr. Hahn, when the voting was tallied, some areas of the expert opinions did not coincide with current textbook information in how to treat lupus nephritis. New scenarios were therefore constructed to clarify the clinical situation. “You find that, with this method, there are some answers that don’t seem to be in line with current practice, and therefore it is likely that people voting did not interpret the scenario in the same way,” Dr. Hahn notes. “Part of the process is to look where there is a lot of discrepancy in people’s opinions. There were different interpretations of scenarios between experts, so we reconstructed [these hypothetical situations].”
Participating doctors were chosen based on their expertise with writing guidelines, their experience with leading large major clinical trials, or a combination of both. Most of the nephrologists chosen to work alongside their ACR counterparts “have worked on U.S. guidelines of nephrology before,” according to Dr. Hahn.
Dr. Hahn also says that one limitation to the guidelines will be the range of products reviewed, because only those products that have gone through high-quality clinical trials in the United States will be seriously considered: “Likely there will be more products released over the next two to three years for management of lupus nephritis … they will be addressed, but we don’t know what will be successful and what won’t be … all we can do is spend a brief time discussing these interesting products.” Dr. Hahn cites belimumab (Benlysta) as an example. Benlysta was recently approved for the treatment of lupus, but its utility in the treatment of lupus nephritis has yet to be studied.
The expected impact of these guidelines is substantial for the rheumatologist in clinical practice. “I think that for clinicians who don’t see many patients with lupus nephritis, it will be helpful because it will be an update on the state of the art,” Dr. Hahn says. “For clinicians quite experienced with lupus nephritis, they will most likely be doing things the way they are recommended anyway … hopefully it will confirm what [they] are already doing.”
Alexandra Schultz is a writer based in New Jersey.