Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, The Basque Country, Spain.
Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, The Basque Country, and Hospital Universitario J. M. Morales Meseguer, Murcia, Spain.
Arthritis Care Res (Hoboken). 2018 Apr;70(4):582-591. doi: 10.1002/acr.23322. Epub 2018 Mar 7.
To analyze the influence of 2 different treatment strategies on general and specific damage accrual in patients with systemic lupus erythematosus (SLE).
Two cohorts were identified according to the responsible physicians: patients treated at the autoimmune diseases unit (ADU), and patients treated by other members of the internal medicine (IM) department. Members of the ADU worked with a protocol including the universal prescription of hydroxychloroquine (HCQ), the use of maximum oral prednisone dosages ≤30 mg/day and maintenance therapy with ≤5 mg/day, by using methylprednisolone pulses and/or early immunosuppressive (IS) drugs. We analyzed the influence of these 2 treatment strategies on damage accrual, both general and domain specific, attributed to glucocorticoids, cardiovascular (CV) disease, SLE, and unclassified, since the diagnosis of disease in patients with a followup ≥5 years.
A total of 74 patients were included in the ADU group and 213 in the IM group. They were comparable for most demographic and lupus-related variables. ADU patients received prednisone later and at lower doses, more methylprednisolone pulses, earlier IS drugs and more HCQ (P < 0.05 for all comparisons). The Systemic Lupus Erythematosus Disease Activity Index score decreased similarly in both cohorts (P = 0.4). Patients in the ADU group were less likely to accrue any damage (P = 0.007). They accrued less glucocorticoid-related (adjusted hazard ratio [HR] 0.23 [95% confidence interval (95% CI) 0.07-0.80]), CV disease (adjusted HR 0.28 [95% CI 0.08-0.95]), and unclassified damage (adjusted HR 0.58 [95% CI 0.3-1.1]). Both groups accrued similar SLE-related damage (adjusted HR 0.84 [95% CI 0.40-1.75]).
The use of reduced oral prednisone doses, which was possible by combining different therapies, reduced glucocorticoid-related damage and improved CV prognosis without increasing damage caused by SLE.
分析 2 种不同治疗策略对系统性红斑狼疮（SLE）患者总体和特定损伤积累的影响。
根据负责医生将患者分为两个队列：在自身免疫性疾病科（ADU）治疗的患者，和在其他内科（IM）成员治疗的患者。ADU 成员遵循包括羟氯喹（HCQ）常规处方、使用最大口服泼尼松剂量≤30mg/天和≤5mg/天的维持治疗、使用甲基强的松龙脉冲和/或早期免疫抑制剂（IS）药物的方案进行治疗。我们分析了这 2 种治疗策略对糖皮质激素、心血管（CV）疾病、SLE 和未分类疾病导致的损伤积累的影响，从疾病诊断后随访≥5 年的患者开始。
共纳入 ADU 组 74 例患者和 IM 组 213 例患者。两组患者的大多数人口统计学和狼疮相关变量均相似。ADU 患者接受泼尼松治疗的时间较晚，剂量较低，使用更多的甲基强的松龙脉冲、更早使用 IS 药物和更多的 HCQ（所有比较均 P<0.05）。两组患者的系统性红斑狼疮疾病活动指数评分下降相似（P=0.4）。ADU 组患者发生任何损伤的可能性较低（P=0.007）。他们发生的糖皮质激素相关损伤（调整后的风险比[HR]0.23[95%置信区间（95%CI）0.07-0.80]）、CV 疾病（调整后的 HR 0.28[95%CI 0.08-0.95]）和未分类损伤（调整后的 HR 0.58[95%CI 0.3-1.1]）较少。两组患者发生的 SLE 相关损伤相似（调整后的 HR 0.84[95%CI 0.40-1.75]）。
通过联合使用不同的治疗方法，减少口服泼尼松剂量，可减少糖皮质激素相关损伤，改善 CV 预后，而不会增加 SLE 引起的损伤。
