Rheumatology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Internal Medicine, Universidade do Estado do Rio De Janeiro, Rua São Francisco Xavier 524, Maracanã, Rio de Janeiro, 20550-900, Brazil.
Adv Rheumatol. 2024 May 8;64(1):38. doi: 10.1186/s42358-024-00366-y.
This study examines the association of standard-of-care systemic lupus erythematosus (SLE) medications with key outcomes such as low disease activity attainment, flares, damage accrual, and steroid-sparing, for which there is current paucity of data.
The Asia Pacific Lupus Collaboration (APLC) prospectively collects data across numerous sites regarding demographic and disease characteristics, medication use, and lupus outcomes. Using propensity score methods and panel logistic regression models, we determined the association between lupus medications and outcomes.
Among 1707 patients followed over 12,689 visits for a median of 2.19 years, 1332 (78.03%) patients achieved the Lupus Low Disease Activity State (LLDAS), 976 (57.18%) experienced flares, and on most visits patients were taking an anti-malarial (69.86%) or immunosuppressive drug (76.37%). Prednisolone, hydroxychloroquine and azathioprine were utilised with similar frequency across all organ domains; methotrexate for musculoskeletal activity. There were differences in medication utilisation between countries, with hydroxychloroquine less frequently, and calcineurin inhibitors more frequently, used in Japan. More patients taking leflunomide, methotrexate, chloroquine/hydroxychloroquine, azathioprine, and mycophenolate mofetil/mycophenolic acid were taking ≤ 7.5 mg/day of prednisolone (compared to > 7.5 mg/day) suggesting a steroid-sparing effect. Patients taking tacrolimus were more likely (Odds Ratio [95% Confidence Interval] 13.58 [2.23-82.78], p = 0.005) to attain LLDAS. Patients taking azathioprine (OR 0.67 [0.53-0.86], p = 0.001) and methotrexate (OR 0.68 [0.47-0.98], p = 0.038) were less likely to attain LLDAS. Patients taking mycophenolate mofetil were less likely to experience a flare (OR 0.79 [0.64-0.97], p = 0.025). None of the drugs was associated with a reduction in damage accrual.
This study suggests a steroid-sparing benefit for most commonly used standard of care immunosuppressants used in SLE treatment, some of which were associated with an increased likelihood of attaining LLDAS, or reduced incidence of flares. It also highlights the unmet need for effective treatments in lupus.
本研究旨在探讨标准治疗系统性红斑狼疮（SLE）药物与疾病活动度达标、发作、损伤累积和类固醇节约等关键结局之间的关联，而这些方面的数据目前还很匮乏。
亚太狼疮协作组（APLC）前瞻性地在多个地点收集有关人口统计学和疾病特征、药物使用和狼疮结局的数据。我们使用倾向评分方法和面板逻辑回归模型来确定狼疮药物与结局之间的关联。
在中位随访时间为 2.19 年、随访次数为 12689 次的 1707 例患者中，1332 例（78.03%）患者达到狼疮低疾病活动状态（LLDAS），976 例（57.18%）患者出现发作，大多数就诊时患者服用抗疟药（69.86%）或免疫抑制剂（76.37%）。在所有器官领域，泼尼松龙、羟氯喹和硫唑嘌呤的使用频率相似；甲氨蝶呤用于治疗肌肉骨骼活动。各国之间的药物使用存在差异，日本较少使用羟氯喹，而较多使用钙调磷酸酶抑制剂。服用来氟米特、甲氨蝶呤、氯喹/羟氯喹、硫唑嘌呤和霉酚酸酯/吗替麦考酚的患者中，服用泼尼松龙≤7.5mg/天的患者（与>7.5mg/天相比）更多，提示有类固醇节约作用。服用他克莫司的患者更有可能（优势比[95%置信区间]13.58[2.23-82.78]，p=0.005）达到 LLDAS。服用硫唑嘌呤（OR 0.67[0.53-0.86]，p=0.001）和甲氨蝶呤（OR 0.68[0.47-0.98]，p=0.038）的患者达到 LLDAS 的可能性较低。服用吗替麦考酚酯的患者发生发作的可能性较低（OR 0.79[0.64-0.97]，p=0.025）。没有一种药物与减少损伤累积有关。
本研究表明，在 SLE 治疗中最常使用的标准治疗免疫抑制剂中，大多数具有类固醇节约作用，其中一些与增加达到 LLDAS 的可能性或减少发作的发生率有关。它还突出了狼疮治疗中有效治疗的未满足需求。
