Nørgaard J C, Stengaard-Pedersen K, Nørgaard M, de Thurah A
Department of Rheumatology
Department of Rheumatology.
Lupus. 2015 Mar;24(3):299-306. doi: 10.1177/0961203314555351. Epub 2014 Oct 15.
Evidence-based international guidelines for the treatment of systemic lupus erythematosus (SLE) recommend treatment with antimalarials (AMs) for all patients with SLE irrespective of disease activity. Only a few studies have investigated the use of AMs among newly diagnosed patients with SLE.
The objective of this paper is to analyze prescription patterns of AMs in newly diagnosed SLE patients in Denmark from 2000 to 2011.
Using the Danish Prescription Register (DNPR), we conducted a nationwide cohort study including all patients with a first-time diagnosis of SLE (the Danish National Registry of Patients (NPR)). We used Kaplan-Meier estimates to compute the cumulative probability of starting AM treatment within a year and Cox regression analysis to compare time to treatment between patient groups.
AMs were prescribed to 37.7% of the newly diagnosed SLE patients within the first year of follow-up. Approximately 20% did not receive any medical treatment. Women were more likely than men to start AM (adjusted HR of 1.28 (95% CI 1.08-1.52)). Patients diagnosed with SLE between 2005 and 2011 were more likely to start treatment than patients diagnosed between 2000 and 2004 (HR of 1.21 (95% CI 1.07-1.36)). Patients with renal disease were less likely to start AM treatment than patients without this condition (adjusted HR of 0.50 (95% CI 0.36-0.68)). Current users of corticosteroids were more likely to start AM treatment than non-users (adjusted HR 1.81 (95% CI 1.59-2.06)).
Time to start of AM treatment following SLE diagnosis could be further reduced, especially among patients with renal disease. However, our results showed that treatment practice in recent years has changed toward initiating AM treatment earlier.
基于证据的系统性红斑狼疮（SLE）国际治疗指南建议，所有SLE患者无论疾病活动度如何，均应使用抗疟药（AM）进行治疗。仅有少数研究调查了新诊断SLE患者中抗疟药的使用情况。
本文旨在分析2000年至2011年丹麦新诊断SLE患者中抗疟药的处方模式。
利用丹麦处方登记册（DNPR），我们开展了一项全国性队列研究，纳入所有首次诊断为SLE的患者（丹麦国家患者登记册（NPR））。我们使用Kaplan-Meier估计法计算一年内开始抗疟药治疗的累积概率，并使用Cox回归分析比较患者组之间的治疗时间。
在随访的第一年，37.7%的新诊断SLE患者接受了抗疟药治疗。约20%的患者未接受任何药物治疗。女性比男性更有可能开始使用抗疟药（调整后风险比为1.28（95%置信区间1.08 - 1.52））。2005年至2011年诊断为SLE的患者比2000年至2004年诊断的患者更有可能开始治疗（风险比为1.21（95%置信区间1.07 - 1.36））。患有肾脏疾病的患者比未患该疾病的患者开始抗疟药治疗的可能性更小（调整后风险比为0.50（95%置信区间0.36 - 0.68））。当前使用皮质类固醇的患者比未使用者更有可能开始抗疟药治疗（调整后风险比1.81（95%置信区间1.59 - 2.06））。
SLE诊断后开始抗疟药治疗的时间可以进一步缩短，尤其是在患有肾脏疾病的患者中。然而，我们的结果表明，近年来的治疗实践已朝着更早开始抗疟药治疗的方向转变。
