Petitdemange Arthur, Felten Renaud, Sibilia Jean, Martin Thierry, Arnaud Laurent
Service de Rhumatologie, Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Service d'Immunologie Clinique et de Médecine Interne, Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Ther Adv Musculoskelet Dis. 2021 May 19;13:1759720X211002595. doi: 10.1177/1759720X211002595. eCollection 2021.
Antimalarial agents (AMs), mainly hydroxychloroquine (HCQ) and chloroquine, are the cornerstone of treatment of cutaneous and systemic lupus erythematosus. However, many aspects of AM prescription remain empirical. The aim of this study was to assess the modalities of AM prescription among physicians treating patients with lupus and to verify the assumption that AM use is heterogeneous and frequently at variance with international guidelines.
We performed an international cross-sectional study among physicians involved in lupus care, using a web-based survey (from September 2019 to July 2020) addressing the main controversial aspects of AM prescription.
A total of 298 physicians [median age: 42 (interquartile range: 17) years, mainly internists and rheumatologists] from 35 countries participated to the study. A total of 93% used HCQ as the first-line AM, 69.5% used fixed doses of AMs (mainly 400 mg/day for HCQ) and only 37.9% adjusted the dose in case of renal failure. The main reasons for measuring HCQ blood levels were suspected non-adherence (55.7%) and failure of AM treatment (34.1%). In case of AM failure, 58.0% added an immunosuppressive agent. In case of remission, 49.7% maintained the same dose of AM, whereas 48.3% reduced the dose. One-third of respondents reported not following the American screening guidelines on AM retinal toxicity and 40.9% started retinal screening from the first year of treatment.
This study highlights the strong heterogeneity of AM prescription in lupus, as well as several key unmet needs regarding AMs. This may be improved by developing more comprehensive recommendations and favoring dissemination among physicians.
抗疟药（AMs），主要是羟氯喹（HCQ）和氯喹，是治疗皮肤型和系统性红斑狼疮的基石。然而，抗疟药的处方在很多方面仍然是经验性的。本研究的目的是评估治疗狼疮患者的医生中抗疟药的处方方式，并验证抗疟药使用存在异质性且经常与国际指南不一致这一假设。
我们对参与狼疮治疗的医生进行了一项国际横断面研究，使用基于网络的调查问卷（2019年9月至2020年7月），涉及抗疟药处方的主要争议方面。
来自35个国家的298名医生[中位年龄：42（四分位间距：17）岁，主要是内科医生和风湿病学家]参与了该研究。共有93%的医生将羟氯喹作为一线抗疟药，69.5%的医生使用固定剂量的抗疟药（羟氯喹主要为每日400毫克），只有37.9%的医生在肾衰竭时调整剂量。检测羟氯喹血药浓度的主要原因是怀疑不依从（55.7%）和抗疟药治疗失败（34.1%）。抗疟药治疗失败时，58.0%的医生加用了免疫抑制剂。病情缓解时，49.7%的医生维持相同剂量的抗疟药，而48.3%的医生减少了剂量。三分之一的受访者表示未遵循美国关于抗疟药视网膜毒性的筛查指南，40.9%的医生从治疗的第一年就开始进行视网膜筛查。
本研究突出了狼疮抗疟药处方的强烈异质性，以及抗疟药方面几个关键的未满足需求。这可以通过制定更全面的建议并促进在医生中的传播来改善。
