Authors (including presenting author) :
So H(1), Chow E(1), Cheng IT(1), Lau SL(1), Li TK(1), Szeto CC(1), Tam LS(1)
Affiliation :
(1)Department of Medicine & Therapeutics, The Chinese University of Hong Kong
Introduction :
Patients with systemic lupus erythematous (SLE) were vulnerable to severe COVID-19 infection and the negative impact of disrupted healthcare delivery. Telemedicine (TM) has been a popular alternative to standard in-person care during the pandemic despite the lack of evidence.
Objectives :
To compare the outcomes of patients with SLE managed by telemedicine (TM) and standard face-to-face consultations during the COVID-19 outbreak.
Methodology :
This was a 1-year, open-label randomized controlled trial conducted at a regional hospital in Hong Kong. From May 2020, consecutive adult patients with a diagnosis of SLE according to the 2019 EULAR/ACR classification criteria followed up at the lupus nephritis clinic were invited to participate in the study. Participants were randomized 1:1 to either TM (TM group) or standard FU (SF group). Patients randomized to receive TM FU were scheduled for a video consultation via a real-time video conferencing software ZOOM. Patients in the SF group received standard in-person outpatient care.
Result & Outcome :
A total of 144 patients with LN were randomized (TM: 72, SF: 72) and 3 patients self-withdrew from the study. At the end of the study (December 2021), 70 patients in the TM group and 71 patients in the SF completed 1-year FU. There were no baseline differences, including demographics, SLEDAI-2k, PGA and SLE damage index (TM: 1.1±1.3, SF: 0.8±1.1, p=0.10), between the 2 groups.
At one year, 80% and 80.2% of the patients in the TM group and SF group were in low disease activity or remission respectively. SLE disease activity indices remained similar between the 2 groups. Within the study period, 28 patients in the TM group and 21 patients in the SF group had disease flare (p=0.20). There were no differences in the SF-36, lupusQoL and HADS scores between the 2 groups at the end of the study. The overall patient satisfaction score was higher in the TM group with a significantly shorter waiting time.
The mean out-of-pocket costs for health care services and indirect costs of illness were similar between the 2 groups. However, significantly more patients in the TM group requested switch of mode of FU. The proportion of patients requiring hospitalization during the study period was also higher in the TM group. After adjusting for age and prednisolone dosage, not being in low disease activity at baseline was the predictor of hospitalization (OR 3.4, 95%CI 1.20-9.65).
To conclude, TM delivered care could help maintaining disease control and psychosocial wellbeing during the pandemic, but it might need to be complemented by physical visits, particularly in those with unstable disease.
