Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, The Basque Country, Spain.
Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, The Basque Country, Spain.
Autoimmun Rev. 2019 Sep;18(9):102359. doi: 10.1016/j.autrev.2019.102359. Epub 2019 Jul 16.
The aim of this study is to compare the frequency of remission, according to DORIS definitions, of inception patients from two European SLE cohorts, with a special focus on the differences between the therapeutic schemes of both Units.
Inception patients enrolled after 2000 from the longitudinal Cruces Lupus Cohort (CC) and Bordeaux Lupus Cohort (BC) were included. The main endpoint was the achievement of clinical remission on treatment (ClinROnT). ClinROnT was assessed yearly from the 1st until the 5th year following the diagnosis of SLE.
173 patients, 92 CC and 81 BC, were studied. The clinical presentation of both cohorts was similar, with no significant differences in the mean SLEDAI score at diagnosis (6.6 vs. 8.1, p = 0.06). Patients from CC were treated more frequently with hydroxychloroquine (mean 57 vs. 43 months), methotrexate (24% vs. 11%) and pulse methyl-prednisolone (42% vs. 26%), and received lower doses of oral prednisone (average dose during the follow up 2.3 vs. 7.2 mg/d, p < 0.001). Patients in CC were more likely to achieve ClinROnT at year one, 84% vs. 43% (p < 0.001). Prolonged ClinROnT during the 5 years of follow up was more frequent in CC: 70% vs. 28%, p < 0.001. Patients in CC were also more likely to achieve ClinROnT after controlling for baseline SLEDAI (adjusted HR 1.69, 95%CI 1.21-2.35) and for the presenting clinical manifestations (adjusted HR 1.72, 95% CI 1.2-2.4).
Prolonged ClinROnT was achievable by using a therapeutic regime consisting of lower doses of oral prednisone and maximizing the use of hydroxychloroquine, pulse methyl-prednisolone and methotrexate.
本研究旨在比较两个欧洲系统性红斑狼疮（SLE）队列的发病患者根据 DORIS 定义的缓解频率，特别关注两个单位治疗方案之间的差异。
纳入了 2000 年后入组的来自纵向 Cruces Lupus 队列（CC）和波尔多狼疮队列（BC）的发病患者。主要终点是治疗达到临床缓解（ClinROnT）。从 SLE 诊断后的第 1 年到第 5 年，每年评估 ClinROnT。
共纳入 173 例患者，92 例来自 CC，81 例来自 BC。两个队列的临床表现相似，诊断时平均 SLEDAI 评分无显著差异（6.6 与 8.1，p=0.06）。CC 患者更常接受羟氯喹（平均 57 个月与 43 个月）、甲氨蝶呤（24%与 11%）和脉冲甲基强的松龙（42%与 26%）治疗，且接受的口服泼尼松剂量较低（随访期间平均剂量 2.3 与 7.2mg/d，p<0.001）。CC 患者在第 1 年达到 ClinROnT 的可能性更高，为 84%与 43%（p<0.001）。在 5 年随访期间，CC 患者持续 ClinROnT 的可能性更高：70%与 28%，p<0.001。在校正基线 SLEDAI（调整后的 HR 1.69，95%CI 1.21-2.35）和临床表现（调整后的 HR 1.72，95%CI 1.2-2.4）后，CC 患者更有可能达到 ClinROnT。
通过使用包括低剂量口服泼尼松和最大限度使用羟氯喹、脉冲甲基强的松龙和甲氨蝶呤的治疗方案，可实现延长 ClinROnT。
