The Pediatric Rheumatology International Trials Organization criteria for the evaluation of response to therapy in juvenile systemic lupus erythematosus: prospective validation of the disease activity core set.
OBJECTIVE
To validate and promulgate a core set of outcome measures for the evaluation of response to treatment in patients with juvenile systemic lupus erythematosus (SLE).


METHODS
In 2001, a preliminary consensus-derived core set of measures for evaluating the response to therapy in juvenile SLE was established. In the present study, the core set was validated through an evidence-based, large-scale data collection process that led to the enrollment of 557 patients from 39 different countries. Consecutive patients with active disease were assessed at baseline and after 6 months. The validation procedures included assessment of feasibility, responsiveness, discriminant and construct ability, agreement in the evaluation of response to therapy between physicians and parents, redundancy, internal consistency, and ability to predict a therapeutic response.


RESULTS
The following clinical measures were found to be feasible and to have good construct validity, discriminative ability, and internal consistency; furthermore, they were not redundant, proved responsive to clinically important changes in disease activity, and were associated strongly with treatment outcome and thus were included in the final core set: 1) physician's global assessment of disease activity, 2) global disease activity measure, 3) 24-hour proteinuria, 4) parent's global assessment of the patient's overall well-being, and 5) health-related quality of life assessment.


CONCLUSIONS
The members of PRINTO propose a core set of criteria for the evaluation of response to therapy that is scientifically and clinically relevant and statistically validated. The core set will help standardize the conduct and reporting of clinical trials and assist practitioners in deciding whether a patient with juvenile SLE has responded adequately to therapy.
Ruperto
Nicolino
N
Pediatric Rheumatology International Trials Organization (PRINTO), IRCCS G. Gaslini, Università di Genova, Pediatria II-Reumatologia, Largo Gaslini, Genoa, Italy. nicolaruperto@ospedale-gaslini.ge.it
Ravelli
Angelo
A
Cuttica
Ruben
R
Espada
Graciela
G
Ozen
Seza
S
Porras
Oscar
O
Sztajnbok
Flavio
F
Falcini
Fernanda
F
Kasapcopur
Ozgur
O
Venning
Helen
H
Bica
Blanca
B
Merino
Rosa
R
Coto
Cecilia
C
Ros
Joan
J
Susic
Gordana
G
Gamir
María Luz
ML
Minden
Kirsten
K
See
Yvonne
Y
Uziel
Yosef
Y
Mukamel
Masha
M
Riley
Phil
P
Zulian
Francesco
F
Olivieri
Alma Nunzia
AN
Cimaz
Rolando
R
Girschick
Hermann
H
Rumba
Ingrida
I
Cavuto
Silvio
S
Pistorio
Angela
A
Lovell
Daniel J
DJ
Martini
Alberto
A
D000203:Activities of Daily Living; D002986:Clinical Trials as Topic / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006304:Health Status; D006801:Humans; D007391:International Cooperation; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D017063:Outcome Assessment, Health Care; D011507:Proteinuria / Q000175:diagnosis; D015203:Reproducibility of Results; D012219:Rheumatology / Q000379:methods* / Q000592:standards; D012720:Severity of Illness Index; D016896:Treatment Outcome