Medicine Based Evidence for Individualized Decision Making: Case Study of Systemic Lupus Erythematosus Ashley E. Wivel, MD, Kate Lapane, PhD, Christi.

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Presentation transcript:

Medicine Based Evidence for Individualized Decision Making: Case Study of Systemic Lupus Erythematosus Ashley E. Wivel, MD, Kate Lapane, PhD, Christi Kleoudis, MS, Burton H. Singer, PhD, Ralph I. Horwitz, MD The American Journal of Medicine Volume 130, Issue 11, Pages 1290-1297.e6 (November 2017) DOI: 10.1016/j.amjmed.2017.06.013 Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure Variables for the first patient narrative. The American Journal of Medicine 2017 130, 1290-1297.e6DOI: (10.1016/j.amjmed.2017.06.013) Copyright © 2017 Elsevier Inc. Terms and Conditions

Supplementary Figure The figure shows the distribution of the outcome based on the trajectory of each biological and social/behavioral variable for patients who were considered responders based on the Systemic lupus erythematosus Responder Index (SRI) at week 52 (Panel A) and patients considered nonresponders based on the SRI index at week 52 (Panel B). In Panel A, regardless of the biological or social/behavioral variable, only half of the patients were considered to have improved or remained stable or low based on their trajectories (range: 47.9% for Short Form [SF]-36 Mental Component Summary [MCS] to 62.7% for complement C3 [C3]). The proportion of patients whose trajectories indicated worsening based on each biological or social/behavioral variable ranged from 19.4% on the Functional Assessment of Chronic Illness Therapy (FACIT) to 35.8% on the EuroQOL 5 dimensions health status measure (EQ-5D) Index. Patients whose trajectories were clinically variable based on each variable ranged from 7.5% for C4 to 29.9% on the SF-36 Physical Component Summary (PCS). Among patients who did not respond based on the SRI at 52 weeks (Panel B), discordance between the 52-week SRI measure and each trajectory distribution was observed. For those classified as nonresponders using the SRI measure at 52 weeks, many patients appeared to have improvements in the biologic measures based on the trajectory algorithms (40.9% for C4 to 61.7% for C-reactive protein [CRP]). Similar patterns were observed for the social/behavioral variables. The discordance between the SRI index at 52 weeks and the trajectory method was apparent among nonresponders as well, with a range of 46.7% for EQ-5D VAS to 49.7% for FACIT appearing to improve or remain stable with low disease activity throughout the year. The American Journal of Medicine 2017 130, 1290-1297.e6DOI: (10.1016/j.amjmed.2017.06.013) Copyright © 2017 Elsevier Inc. Terms and Conditions