Paredes-Ruiz Diana, Martin-Iglesias Daniel, Ruiz-Irastorza Guillermo
Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, The Basque Country, Spain.
Department of Medicine, University of the Basque Country, The Basque Country, Spain.
Expert Rev Clin Immunol. 2024 Apr;20(4):359-373. doi: 10.1080/1744666X.2023.2294938. Epub 2023 Dec 25.
Hydroxychloroquine (HCQ) and glucocorticoids (GCs) constitute the oldest and more used drugs in the treatment of systemic lupus erythematosus (SLE). Despite this long experience, both are still subject to a number of uncertainties, mainly regarding the dose.
We review the main mechanisms of action, the clinical and toxic effects of HCQ and GCs and analyze the recommendations for the use of both in guidelines published since 2018. We offer a set of recommendations based on the pharmacology, mechanisms of action and clinical evidence.
HCQ is the backbone therapy for SLE, and a judicious use must be accomplished, using doses that allow a good control of lupus without compromising the safety of treatments very much prolonged over the time. Stable doses of 200 mg/day seem to accomplish both conditions. GCs should be used more judiciously, with methyl-prednisolone pulses as the main therapy for inducing rapid remission and doses ≤5-2.5 mg/day be never exceeded in long-term maintenance treatments.
羟氯喹（HCQ）和糖皮质激素（GCs）是治疗系统性红斑狼疮（SLE）最古老且使用最广泛的药物。尽管有长期的使用经验，但这两种药物仍存在一些不确定性，主要涉及剂量方面。
我们回顾了HCQ和GCs的主要作用机制、临床及毒性作用，并分析了自2018年以来发布的指南中关于两者使用的建议。我们基于药理学、作用机制和临床证据提供了一系列建议。
HCQ是SLE的基础治疗药物，必须谨慎使用，采用能良好控制狼疮且不会过度危及长期治疗安全性的剂量。稳定剂量200毫克/天似乎能满足这两个条件。GCs的使用应更加谨慎，甲基泼尼松龙冲击疗法作为诱导快速缓解的主要治疗方法，长期维持治疗中每日剂量绝不超过5 - 2.5毫克。
