Department of Rheumatology, Institute of Post Graduate Medical Education and Research, 240 AJC Bose Road, Kolkata, West Bengal, India.
Clin Rheumatol. 2019 Apr;38(4):1089-1097. doi: 10.1007/s10067-018-4377-7. Epub 2018 Dec 6.
Whether maintaining steroid-free remission is feasible in Indian patients with systemic lupus erythematosus (SLE).
In 148 patients with SLE including 78 lupus nephritis (LN) previously put into remission, steroid therapy was gradually tapered off.
Patients received glucocorticoids for median 1855 days (interquartile range (IQR) 901-2834) before discontinuing. Median duration of follow-up was 539 days (IQR 266.25-840.75). Flare occurred in 31 patients (20.9%; 95% confidence interval (CI) 15.17-28.19, renal flare in 12.16% (18/148, 95% CI 7.83-18.41)). Most of the flares occurred in the first year of follow-up (41.9%, 13/31). Overall 93.5% (29/31) of flares occurred in those who received ≤ 8 years of glucocorticoids, compared to 6.5% (2/31) of flares in others (p = 0.009). Median flare-free survival was 611 days (95% CI 518-704). Multivariate Cox regression identified the following predictors of flare-free survival: duration of disease (hazard ratio (HR) 0.89, 95% CI 0.84-0.94, p < 0.001), duration of glucocorticoid before discontinuing (HR 1.000086, 95% CI 1.000047-1.00012, p < 0.001) and second immunosuppressive (HR 1.89, 95% CI 1.251-2.87, p = 0.003). Additional risk factors of a renal flare-free survival among patients with LN were initial dose of glucocorticoids (HR 0.97, 95% CI 0.94-0.99, p = 0.005) and presence of haemolytic anaemia (HR 2.43, 95% CI 1.067-5.54, p = 0.035).
About 20% patients undergo exacerbation of disease activity after glucocorticoid withdrawal. Treatment for ≥ 8 years before discontinuing and an additional immunosuppressive agent improve the chance of flare-free survival.
评估在印度系统性红斑狼疮（SLE）患者中维持无激素缓解是否可行。
对 148 例 SLE 患者（包括 78 例狼疮肾炎（LN）患者）进行回顾性分析，这些患者先前已进入缓解期，随后逐渐减少激素治疗。
患者在停药前接受糖皮质激素治疗的中位时间为 1855 天（四分位距（IQR）901-2834）。中位随访时间为 539 天（IQR 266.25-840.75）。31 例（20.9%；95%置信区间（CI）15.17-28.19，肾部复发率为 12.16%（18/148，95%CI 7.83-18.41））出现病情活动。大多数病情活动发生在随访的第一年（41.9%，13/31）。总体而言，93.5%（29/31）的复发发生在接受糖皮质激素治疗≤8 年的患者中，而其他患者（2/31）的复发率为 6.5%（p=0.009）。无复发的中位生存时间为 611 天（95%CI 518-704）。多变量 Cox 回归分析确定了无复发生存的以下预测因素：疾病持续时间（风险比（HR）0.89，95%CI 0.84-0.94，p<0.001）、停药前糖皮质激素治疗持续时间（HR 1.000086，95%CI 1.000047-1.00012，p<0.001）和第二种免疫抑制剂（HR 1.89，95%CI 1.251-2.87，p=0.003）。LN 患者的肾无复发生存的其他危险因素包括初始糖皮质激素剂量（HR 0.97，95%CI 0.94-0.99，p=0.005）和溶血性贫血的存在（HR 2.43，95%CI 1.067-5.54，p=0.035）。
约 20%的患者在停用糖皮质激素后会出现病情活动加重。停药前治疗≥8 年和使用额外的免疫抑制剂可提高无复发生存的机会。
