Department of Rheumatology/Clinical Immunology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama 350-8550, Japan.
Lupus. 2010 Feb;19(2):162-9. doi: 10.1177/0961203309350320. Epub 2009 Dec 1.
We investigated the efficacy and safety of cyclosporine A (CsA; targeted serum trough level: 80-150 ng/ml) in a daily clinical practice for treating patients with systemic lupus erythematosus (SLE), who had been, or were expected to be, refractory to glucocorticoids (GCs) and other immunosuppressants. Fifty-nine patients with SLE receiving CsA were observed for at least 6 months (21.5 months on average). A significant reduction of proteinuria was noted 2 weeks after initiation of treatment in patients with nephritis, resulting in a clinical response in five of eight patients in the GC dose-up group and 11 of 18 patients in the stable GC dose group, respectively. Notably, the mean score for disease activity on the SLE Disease Activity Index decreased significantly from 8.6 +/- 5.3 to 4.4 +/- 2.5 after CsA treatment in patients in the stable GC dose group (n = 40). Moreover, the mean flare rate decreased by approximately 60% with CsA. Side effects of CsA appeared in 32.2% of patients and all of them subsided through dose reduction or discontinuation (n=8) of CsA. Consequently, the cumulative 2-year survival rate of CsA was 75%. The results suggest that CsA should be considered for patients with SLE refractory to GCs.
我们研究了环孢素 A（CsA；目标血清谷浓度：80-150ng/ml）在治疗对糖皮质激素（GCs）和其他免疫抑制剂有反应或预计有反应的系统性红斑狼疮（SLE）患者中的疗效和安全性。我们观察了 59 例接受 CsA 治疗的 SLE 患者，至少随访 6 个月（平均 21.5 个月）。在肾炎患者中，治疗开始后 2 周即可观察到蛋白尿显著减少，导致 GC 剂量递增组的 8 例患者中的 5 例和稳定 GC 剂量组的 18 例患者中的 11 例分别出现临床反应。值得注意的是，在稳定 GC 剂量组的 40 例患者中，SLE 疾病活动指数的平均评分从治疗前的 8.6+/-5.3 显著下降至 4.4+/-2.5（n=40）。此外，CsA 治疗后平均发作率降低了约 60%。CsA 出现 32.2%的患者出现副作用，所有患者通过减少剂量或停止 CsA（n=8）后均得到缓解。因此，CsA 的 2 年累积生存率为 75%。结果表明，CsA 应考虑用于对 GCs 有反应的 SLE 患者。
