Guangzhou University of Chinese Medicine, Guangzhou, China.
The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Int J Rheum Dis. 2023 Sep;26(9):1686-1696. doi: 10.1111/1756-185X.14791. Epub 2023 Jul 26.
Many studies have found that glucocorticoid (GC) combined with hydroxychloroquine (HCQ) has a good clinical effect in the treatment of systemic lupus erythematosus (SLE) rash, but there is no relevant systematic evaluation at present. The purpose of this study was to systematically evaluate and analyze the effectiveness and safety of GC combined with HCQ in the treatment of SLE rash.
Randomized controlled trials of GC combined with HCQ in the treatment of SLE rash were collected through computer retrieval of Cochrane Library, PubMed, Embase, CNKI, China Science and Technology Journal Database (VIP), Wanfang Data Knowledge Service Platform (Wanfang), and China Biology Medicine disc (CBM) since the establishment of the database. The main outcome indicators included clinical total effective rate, adverse reactions, SLE disease activity index (SLEDAI) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complement 3 (C3). A meta-analysis was conducted using Review Manager 5.3 software.
A total of 11 studies involving 809 patients (406 in the test group and 403 in the control group) were included in this article. The meta-analysis results showed that compared with the single use of GC, GC combined with HCQ could improve the clinical total effective rate in the treatment of SLE rash (odds ratio [OR] = 4.27, 95% confidence interval [CI] 2.50-7.30, p < .00001), and reduce the occurrence of adverse reactions (OR = 0.26, 95% CI 0.15-0.44, p < .00001); effectively reduce SLEDAI score (mean difference [MD] = 1.88, 95% CI 1.66-2.10, p < .00001) and ESR level (MD = 7.92, 95% CI 5.66-10.19, p < .00001); increase C3 level after treatment (MD = 0.36, 95% CI 0.32-0.41, p < .00001); and reduce CRP level (MD = 3.22, 95% CI 2.87-3.58, p < .00001), with statistically significant differences.
Compared with the use of GC alone, GC combined with HCQ can improve the clinical effectiveness of SLE rash treatment, with a low incidence of adverse reactions and good clinical safety. However, the number and quality of studies included in this article were not high, so the findings need to be further verified by high-quality, multicenter randomized controlled trials.
许多研究发现，糖皮质激素（GC）联合羟氯喹（HCQ）在治疗系统性红斑狼疮（SLE）皮疹方面具有良好的临床疗效，但目前尚无相关系统评价。本研究旨在系统评价和分析 GC 联合 HCQ 治疗 SLE 皮疹的疗效和安全性。
通过计算机检索 Cochrane 图书馆、PubMed、Embase、中国知网（CNKI）、中国科技期刊数据库（VIP）、万方数据知识服务平台（Wanfang）和中国生物医学文献数据库（CBM），收集 GC 联合 HCQ 治疗 SLE 皮疹的随机对照试验。主要结局指标包括临床总有效率、不良反应、SLE 疾病活动指数（SLEDAI）评分、红细胞沉降率（ESR）、C 反应蛋白（CRP）和补体 3（C3）。使用 Review Manager 5.3 软件进行荟萃分析。
共纳入 11 项研究，涉及 809 例患者（试验组 406 例，对照组 403 例）。荟萃分析结果显示，与单独使用 GC 相比，GC 联合 HCQ 可提高 SLE 皮疹治疗的临床总有效率（比值比[OR] = 4.27，95%置信区间[CI] 2.50-7.30，p < .00001），减少不良反应的发生（OR = 0.26，95% CI 0.15-0.44，p < .00001）；有效降低 SLEDAI 评分（均差[MD] = 1.88，95% CI 1.66-2.10，p < .00001）和 ESR 水平（MD = 7.92，95% CI 5.66-10.19，p < .00001）；治疗后 C3 水平升高（MD = 0.36，95% CI 0.32-0.41，p < .00001）；降低 CRP 水平（MD = 3.22，95% CI 2.87-3.58，p < .00001），差异均有统计学意义。
与单独使用 GC 相比，GC 联合 HCQ 可提高 SLE 皮疹治疗的临床疗效，不良反应发生率低，临床安全性好。但纳入研究的数量和质量不高，需要高质量、多中心的随机对照试验进一步验证。
