Thalidomide treatment in cutaneous lesions of systemic lupus erythematosus: a multicenter study in China
Thalidomide treatment in cutaneous lesions of systemic lupus erythematosus: a multicenter study in China
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沙利度胺治疗系统性红斑狼疮皮损：中国多中心研究
DOI：
10.1007/s10067-016-3256-3
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发表时间：
2016-06-01
影响因子：
3.4
通讯作者：
Sun, Lingyun
中科院分区：
文献类型：
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作者：
Wang, Dandan;Chen, Haifeng;Sun, Lingyun
沙利度胺是治疗重症皮肤狼疮的有效药物。本研究的目的是观察沙利度胺治疗中国皮肤性狼疮的最佳有效剂量和维持剂量，以最大限度地提高临床效益，最大限度减少副作用。对中国8家医院收治的69例狼疮患者给予不同剂量的沙利度胺治疗。我们开始每天服用沙利度胺25 mg，然后逐渐增加剂量，每周一次，直到红斑明显改善。记录有效剂量和维持剂量。每周记录一次皮损的大小。观察治疗前后系统性红斑狼疮疾病活动指数评分、血沉及血清肿瘤坏死因子-α水平的变化。缓解率每周评估一次，直到8周。68%的患者显示每天的有效剂量为50亿毫克；另有13%、10%和9%的患者的有效剂量分别为每天100、75和2500万毫克。71%的患者每天的维持量为50g，9%、14%和6%的患者每天的维持量为100、75和25g。沙利度胺治疗4周后，SLEDAI评分和血清ESR水平明显下降。第4周末完全缓解、部分缓解和无反应率分别为56%(n= 39)、41%(n= 28)和3%(n= 2)。第8周，总缓解率上升至100%。最常见的副作用是嗜睡和便秘。这些患者均未发现周围神经病变。在中国皮肤狼疮患者的治疗中，每天50 mg的沙利度胺可能会提供更好的益处与风险比。
Thalidomide is effective for treating severe cutaneous lupus patients. The aim of this study was to observe the optimum effective and maintenance doses of thalidomide to maximize clinical benefit and minimize side effects for patients with cutaneous lupus in China. Sixty-nine patients with lupus rash from eight hospitals in China were enrolled and treated with different doses of thalidomide. We started the dose of thalidomide at 25 mg daily and gradually increased administration dose once a week until erythema was markedly improved. The effective and maintenance doses were documented. The size of skin lesions was noted once a week. Systemic lupus erythematosus disease activity index (SLEDAI) score, levels of erythrocyte sedimentation rate (ESR), and serum TNF-α were measured before and after treatment. The remission rates were evaluated weekly until 8 weeks. Sixty-eight percent of patients showed an effective dose of 50 mg daily; another 13, 10, and 9 % of patients had an effective dose of 100, 75, and 25 mg daily, respectively. The maintenance dose was 50 mg daily for 71 % of the patients, and 100, 75, and 25 mg daily for 9, 14, and 6 % of the patients. SLEDAI score and serum ESR levels significantly decreased 4 weeks after thalidomide treatment. At the end of the fourth week, the rates of complete remission, partial remission, and no response were 56 % (n= 39), 41 % (n= 28), and 3 % (n= 2). At the eighth week, the rate of total remission rose up to 100 %. The most common side effects were drowsiness and constipation. No peripheral neuropathy was observed in these patients. Thalidomide at a dose of 50 mg daily may offer a better benefit to risk ratio in the treatment of Chinese cutaneous lupus patients.