Advancing treat-to-target in SLE: a pilot study using a clinical decision support system
Objective To 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.Methods A 24-week, non-randomised, multicentre, clustered pilot study was conducted across four r...
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| Format: | Article |
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BMJ Publishing Group
2025-08-01
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| Series: | Lupus Science and Medicine |
| Online Access: | https://lupus.bmj.com/content/12/2/e001605.full |
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| author | Ronald F van Vollenhoven Koen Vos Alexandre Voskuyl Irene E M Bultink Michel Tsang-a-Sjoe Agner R Parra Sánchez Odile van Hall |
| author_facet | Ronald F van Vollenhoven Koen Vos Alexandre Voskuyl Irene E M Bultink Michel Tsang-a-Sjoe Agner R Parra Sánchez Odile van Hall |
| author_sort | Ronald F van Vollenhoven |
| collection | DOAJ |
| description | Objective To 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.Methods A 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.Results Of 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.Conclusions Implementation 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. |
| format | Article |
| id | doaj-art-fb2d8cc2f09e4d5da5f8aaecb4ba8e73 |
| institution | Kabale University |
| issn | 2053-8790 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Lupus Science and Medicine |
| spelling | doaj-art-fb2d8cc2f09e4d5da5f8aaecb4ba8e732025-08-22T11:35:53ZengBMJ Publishing GroupLupus Science and Medicine2053-87902025-08-0112210.1136/lupus-2025-001605Advancing treat-to-target in SLE: a pilot study using a clinical decision support systemRonald F van Vollenhoven0Koen Vos1Alexandre Voskuyl2Irene E M Bultink3Michel Tsang-a-Sjoe4Agner R Parra Sánchez5Odile van Hall6Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands1 Amsterdam Rheumatology and Immunology Center (ARC) | Department of Clinical Immunology and Rheumatology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands1 Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands1 Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands1 Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie AMC, Amsterdam, The NetherlandsRheumatology and Clinical Immunology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands2 Amsterdam Rheumatology and Immunology Center, Amsterdam, The NetherlandsObjective To 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.Methods A 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.Results Of 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.Conclusions Implementation 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.https://lupus.bmj.com/content/12/2/e001605.full |
| spellingShingle | Ronald F van Vollenhoven Koen Vos Alexandre Voskuyl Irene E M Bultink Michel Tsang-a-Sjoe Agner R Parra Sánchez Odile van Hall Advancing treat-to-target in SLE: a pilot study using a clinical decision support system Lupus Science and Medicine |
| title | Advancing treat-to-target in SLE: a pilot study using a clinical decision support system |
| title_full | Advancing treat-to-target in SLE: a pilot study using a clinical decision support system |
| title_fullStr | Advancing treat-to-target in SLE: a pilot study using a clinical decision support system |
| title_full_unstemmed | Advancing treat-to-target in SLE: a pilot study using a clinical decision support system |
| title_short | Advancing treat-to-target in SLE: a pilot study using a clinical decision support system |
| title_sort | advancing treat to target in sle a pilot study using a clinical decision support system |
| url | https://lupus.bmj.com/content/12/2/e001605.full |
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