Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Lupus Sci Med. 2024 Jul 23;11(2):e001207. doi: 10.1136/lupus-2024-001207.
To analyse the response to immunosuppressants (IS) in extrarenal flares of SLE to determine the most appropriate timing during follow-up for a change in therapeutic strategy.
Observational cohort study including a total of 81 patients with SLE with extrarenal flares requiring a change in IS over the period 2015-2022. Baseline clinical variables were described, and follow-up data at 1, 3, 6 and 12 months time-points were collected.
Among patients flaring that achieved lupus low disease activity state (LLDAS5) at 12 months of follow-up, we identified two subgroups ('late responders' and 'early responders'), which showed no significant differences in demographic characteristics, baseline clinical data, cumulative dosage of glucocorticoids or type of IS. Cox model analysis revealed a significant association of a change in IS (p=0.019) and achieving LLDAS5. Contingency table analysis indicated a significant relationship (p=0.004) between IS change at 6 months and individuals achieving LLDAS5 and remission at 12 months.
Our findings suggest that clinical improvement of extrarenal flares typically occurs within 6 months of initiating IS. This timeframe could represent an appropriate timing to evaluate the response in a treat-to-target approach in SLE.
分析狼疮肾炎（SLE）肾外发作时免疫抑制剂（IS）的反应，以确定在随访过程中改变治疗策略的最佳时机。
这是一项包括 2015 年至 2022 年期间共 81 例肾外发作需要改变 IS 的 SLE 患者的观察性队列研究。描述了基线临床变量，并收集了 1、3、6 和 12 个月时的随访数据。
在随访 12 个月时达到狼疮低疾病活动状态（LLDAS5）的患者中，我们确定了两个亚组（“晚期反应者”和“早期反应者”），两组在人口统计学特征、基线临床数据、累积糖皮质激素剂量或 IS 类型方面均无显著差异。Cox 模型分析显示 IS 改变（p=0.019）与达到 LLDAS5 显著相关。列联表分析表明，在 6 个月时改变 IS 与在 12 个月时达到 LLDAS5 和缓解之间存在显著关系（p=0.004）。
我们的研究结果表明，肾外发作的临床改善通常发生在开始 IS 后 6 个月内。这一时间范围可能代表在 SLE 中进行靶向治疗以评估反应的适当时机。
