Ruiz-Irastorza Guillermo, García Miriam, Espinosa Gerard, Cabezas-Rodríguez Ivan, Mitjavila Francesca, González-León Rocío, Sopeña Bernardo, Perales Isabel, Pinilla Blanca, Rodríguez-Carballeira Mónica, López-Dupla Jesús Miguel, Callejas Jose Luis, Castro Antonio, Tolosa Carles, Sánchez-García María Esther, Pérez-Conesa Mercedes, Navarrete-Navarrete Nuria, Rodríguez Ana Paula, Herranz María Teresa, Pallarés Lucio
Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Bizkaia, Spain.
Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain.
Clin Exp Rheumatol. 2016 May-Jun;34(3):466-72. Epub 2016 Feb 26.
This is the first Spanish multicentric inception lupus cohort, formed by SLE patients attending Spanish Internal Medicine Services since January 2009. We aimed to analyse drug therapy during the first year of follow-up according to disease severity.
223 patients who had at least one year of follow-up were enrolled upon diagnosis of SLE. Therapy with prednisone, pulse methyl-prednisolone, hydroxychloroquine, immunosuppressives and calcium/vitamin D was analysed.
Prednisone was given to 65% patients, at a mean (SD) daily dose of 11 (10) mg/d. 38% patients received average doses >7.5 mg/d during the first year. Patients with nephritis and with a SLEDAI ≥6 were treated with higher doses of prednisone. 81% of patients were treated with hydroxychloroquine, with higher frequency among those with a SLEDAI ≥6 (88% vs. 68%, p<0.001). The use of immunosuppressive drugs and methyl-prednisolone pulses was higher in patients with a baseline SLEDAI ≥6, however, differences were no longer significant when patients with lupus nephritis were excluded. The use of calcium/vitamin D increased with the dose of prednisone, however, 43% of patients on medium-high doses of prednisone did not take any calcium or vitamin D.
This study gives a real-world view of the current therapeutic approach to early lupus in Spain. The generalised use of hydroxychloroquine is well consolidated. There is still a tendency to use prednisone at medium to high doses. Pulse methyl-prednisolone and immunosuppressive drugs were used in more severe cases, but not as steroid sparing agents. Vitamin D use was suboptimal.
这是首个西班牙多中心起始性狼疮队列研究，由自2009年1月起就诊于西班牙内科服务机构的系统性红斑狼疮（SLE）患者组成。我们旨在根据疾病严重程度分析随访第一年期间的药物治疗情况。
223例至少有一年随访期的患者在确诊SLE时入组。分析了泼尼松、甲泼尼龙冲击治疗、羟氯喹、免疫抑制剂以及钙/维生素D的治疗情况。
65%的患者使用了泼尼松，平均（标准差）日剂量为11（10）mg/d。38%的患者在第一年期间接受的平均剂量>7.5 mg/d。肾炎患者以及系统性红斑狼疮疾病活动指数（SLEDAI）≥6的患者接受了更高剂量的泼尼松治疗。81%的患者接受了羟氯喹治疗，SLEDAI≥6的患者中使用频率更高（88%对68%，p<0.001）。基线SLEDAI≥6的患者使用免疫抑制剂和甲泼尼龙冲击治疗的比例更高，然而，排除狼疮性肾炎患者后差异不再显著。钙/维生素D的使用随着泼尼松剂量的增加而增加，然而，43%接受中高剂量泼尼松治疗的患者未服用任何钙或维生素D。
本研究呈现了西班牙目前早期狼疮治疗方法的真实情况。羟氯喹的广泛使用已得到充分巩固。仍有使用中高剂量泼尼松的趋势。甲泼尼龙冲击治疗和免疫抑制剂用于更严重的病例，但并非作为激素节省剂。维生素D的使用未达最佳水平。
