Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
Ann Rheum Dis. 2024 Jul 15;83(8):998-1005. doi: 10.1136/ard-2023-225369.
To assess the risk of flare and damage accrual after tapering glucocorticoids (GCs) in modified serologically active clinically quiescent (mSACQ) patients with systemic lupus erythematosus (SLE).
Data from a 12-country longitudinal SLE cohort, collected prospectively between 2013 and 2020, were analysed. SLE patients with mSACQ defined as the state with serological activity (increased anti-dsDNA and/or hypocomplementemia) but without clinical activity, treated with ≤7.5 mg/day of prednisolone-equivalent GCs and not-considering duration, were studied. The risk of subsequent flare or damage accrual per 1 mg decrease of prednisolone was assessed using Cox proportional hazard models while adjusting for confounders. Observation periods were 2 years and censored if each event occurred.
Data from 1850 mSACQ patients were analysed: 742, 271 and 180 patients experienced overall flare, severe flare and damage accrual, respectively. Tapering GCs by 1 mg/day of prednisolone was not associated with increased risk of overall or severe flare: adjusted HRs 1.02 (95% CI, 0.99 to 1.05) and 0.98 (95% CI, 0.96 to 1.004), respectively. Antimalarial use was associated with decreased flare risk. Tapering GCs was associated with decreased risk of damage accrual (adjusted HR 0.96, 95% CI, 0.93 to 0.99) in the patients whose initial prednisolone dosages were >5 mg/day.
In mSACQ patients, tapering GCs was not associated with increased flare risk. Antimalarial use was associated with decreased flare risk. Tapering GCs protected mSACQ patients treated with >5 mg/day of prednisolone against damage accrual. These findings suggest that cautious GC tapering is feasible and can reduce GC use in mSACQ patients.
评估在系统性红斑狼疮（SLE）中经改良血清学活动临床静止（mSACQ）的患者中逐渐减少糖皮质激素（GC）后出现疾病活动和损伤累积的风险。
分析了 2013 年至 2020 年期间前瞻性收集的来自 12 个国家的纵向 SLE 队列的数据。研究对象为 mSACQ 定义为血清学活性（抗 dsDNA 增加和/或低补体血症）但无临床活动，接受 ≤7.5mg/天泼尼松龙等效 GC 治疗且不考虑时间的 SLE 患者。使用 Cox 比例风险模型评估每减少 1mg 泼尼松龙后随后发生疾病活动或损伤累积的风险，同时调整混杂因素。观察期为 2 年，如果发生每个事件则进行截尾。
共分析了 1850 例 mSACQ 患者的数据：742、271 和 180 例患者分别经历了总体疾病活动、严重疾病活动和损伤累积。每天减少 1mg 泼尼松龙的 GC 减量与总体或严重疾病活动风险增加无关：调整后的 HR 分别为 1.02（95%CI，0.99 至 1.05）和 0.98（95%CI，0.96 至 1.004）。使用抗疟药与降低疾病活动风险相关。在初始泼尼松龙剂量>5mg/天的患者中，逐渐减少 GC 与降低损伤累积风险相关（调整后的 HR 0.96，95%CI，0.93 至 0.99）。
在 mSACQ 患者中，逐渐减少 GC 与疾病活动风险增加无关。使用抗疟药与降低疾病活动风险相关。逐渐减少 GC 可预防接受>5mg/天泼尼松龙治疗的 mSACQ 患者的损伤累积。这些发现表明，谨慎的 GC 减量是可行的，并可以减少 mSACQ 患者的 GC 用量。
