Jason Springer MD MS Mei Liu PhD TAPIR trial Jason Springer MD MS Mei Liu PhD

TAPIR computable phenotype GPA computable phenotype (446.4-[288.3 OR 493.*]) + [446.4 on 3 consecutive days OR 446.4 twice 3 months apart] + [Seen by Rheumatology OR Nephrology OR ENT OR Pulmonology] PPV (at KUMC) = 86% TAPIR computable phenotype + Visit in last year + prednisone script in the last year TAPIR computable phenotype

Identifying Specialists Steps done at KUMC Identify specialists seeing patients as outpatient Reason: Specialists only seeing patient on inpatient service will not be following long- term Note: ENT physicians will typically not be managing long term prednisone Identifying Specialists Specialist (outpatient) Percentage of GPA list seen Rheumatology 89% (63/71) Pulmonology 45% (32/71) Nephrology 8% (6/71) ENT 61% (43/71) Rheum OR Pulm 93% (66/71) Rheum OR Pulm OR Neph 97% (69/71) Rheum OR Pulm OR Neph OR ENT 100%

Advertising TAPIR (prior to starting trial) Two approaches: Contact Division Directors Rheumatology Pulmonary Nephrology Mass e-mail to individual specialists Advertising TAPIR (prior to starting trial)

Compensation Patients Compensation through V-PPRN At Enrollment, completion of trial and completion of surveys Physicians (per patient) $25 after completing initial questionnaire + patient enrollment $25 upon completion of study Compensation

Treating Physician’s (specialist’s) role Complete questionnaire 5 questions Can we contact your patient? (yes/no) Confirmation that patient is eligible for this study (yes/no) Study prednisone dose of either 5mg per day or 0mg per day is appropriate treatment for patient. (yes/no) Agreement to be contacted for a brief telephone interview regarding experience with assisting my patient to enroll in this study (optional, yes/no) Indicate plan to taper patient’s prednisone dose down to 5mg/d (or 0mg/d if they are randomized to the 0mg/day study arm) Treating Physician’s (specialist’s) role

Established diagnosis of granulomatosis with polyangiitis (GPA) Fulfills 1990 ACR criteria Active disease within the prior 12 months that at time of active disease required treatment with prednisone ≥ 20mg/day Disease remission at time of enrollment Prednisone dose at time of enrollment between 5- 20mg/day Note: subjects can be on other medications for control of GPA besides prednisone and still participate) Age of 18 years or greater Inclusion Criteria

Comorbid condition that has a moderate likelihood of requiring steroids (COPD, asthma, adrenal insufficiency, etc) Exclusion Criteria

What the physician does not have to do Alter their treatment strategy No change in non-steroid therapies Get IRB approval Not considered a part of study team Fax medical records to the V-PPRN GPC will obtain the medical records What the physician does not have to do

RedCap MRN, PROV, … … MRN, PROV, Eligible?, StudyID, … Study Coordinator + Physician Patient enrolls at TAPIR consent portal Import KUMC will generate a random ID Contact Patient + StudyID TAPIR notify KUMC that Patient “X” has enrolled, provides informed consent Data extraction at end of study Jason will conduct the chart review