Key result
Marked regional treatment disparities exist in idiopathic inflammatory myopathies, with immunosuppressants mostly used in higher-middle income and IVIG/biologics limited to high-income countries.
Cross-Sectional (n=1,418)
Yes
There are marked regional and income-based disparities in the treatment of idiopathic inflammatory myopathies globally, highlighting the need for international consensus guidelines.
Answers are grounded in this paper and cite their sources.
IIM treatment disparities by income highlight access inequities; hypothesis-generating for equitable guidelines, should not yet change practice.
OBJECTIVES: We aimed to explore current practice and interregional differences in the treatment of idiopathic inflammatory myopathies (IIMs). We triangulated these observations considering countries' gross national income (GNI), disease subtypes, and symptoms using patient-reported information. METHODS: A cross-sectional ancillary analysis of the 'COVID-19 vaccination in auto-immune disease' (COVAD) e-survey containing demographic characteristics, IIM subtypes (DM, PM, IBM, anti-synthetase syndrome [ASSD], immune-mediated necrotizing myopathy [IMNM], overlap myopathies [OM]), current symptoms (surrogate for organ involvement) and treatments (corticosteroids [CS], immunomodulators [IM], i.e. antimalarials, immunosuppressants [IS], IVIG, biologic treatments and targeted-synthetic small molecules). Treatments were presented descriptively according to continents, GNI, IIM and organ involvement, and associated factors were analysed using multivariable binary logistic regressions. RESULTS: Of 18 851 respondents from 94 countries, 1418 with IIM were analysed (age 61 years, 62.5% females). DM (32.4%), IBM (24.5%) and OM (15.8%) were the most common subtypes. Treatment categories included IS (49.4%), CS (38.5%), IM (13.8%) and IVIG (9.4%). Notably, treatments varied across regions, GNI categories (IS mostly used in higher-middle income, IM in lower-middle income, IVIG and biologics largely limited to high-income countries), IIM subtypes (IS and CS associated with ASSD, IM with OM and DM, IVIG with IMNM, and biologic treatments with OM and ASSD) and disease manifestations (IS and CS with dyspnoea). Most inter-regional treatment disparities persisted after multivariable analysis. CONCLUSION: We identified marked regional treatment disparities in a global cohort of IIM. These observations highlight the need for international consensus-driven management guidelines considering patient-centred care and available resources.
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Ziadé et al. (2023) conducted a cross-sectional in Idiopathic inflammatory myopathies (IIMs) (n=1,418). Region and gross national income (GNI) was evaluated on Treatment patterns and disparities. Marked regional treatment disparities exist in idiopathic inflammatory myopathies, with immunosuppressants mostly used in higher-middle income and IVIG/biologics limited to high-income countries.
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