Lupus low disease activity state within 12 months is associated with favourable outcomes in severely active systemic lupus erythematosus
Lupus low disease activity state within 12 months is associated with favourable outcomes in severely active systemic lupus erythematosus
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12 个月内狼疮低疾病活动状态与严重活动性系统性红斑狼疮的良好结局相关
DOI：
10.1093/rheumatology/keac002
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发表时间：
2022
期刊：
影响因子：
5.5
通讯作者：
Takeuchi Tsutomu
中科院分区：
文献类型：
--
作者：
Kikuchi Jun;Hanaoka Hironari;Saito Shuntaro;Oshige Tatsuhiro;Hiramoto Kazuoto;Kaneko Yuko;Takeuchi Tsutomu
Objectivesto demonstrate the meaningful of the time to reach lupus low disease activity state（LLDAS）after remission induction therapy in severe active SLE. Methods我们招募了79例活动性狼疮患者，开始泼尼松龙≥0.4 mg/kg/day，BILAG 2004指数A ≥ 1或B ≥ 2，或根据雌激素在红斑狼疮中的安全性国家评估-SLE疾病活动指数（SELENA-SLEDAI）的严重发作。达到LLDAS的时间分为≤6，6-12和>12个月和非LLDAS; LLDAS和耀斑，损害的积累和≥ 50%LLDAS的实现之间的时间关联examined.ResultsThe平均SLEDAI为17;泼尼松龙的中位起始剂量，0.95毫克/公斤/天;和平均观察期，39.7个月。6例（7.6%）和41例（51.9%）患者在6个月和12个月内达到LLDAS。达到LLDAS时间较短的患者更有可能在LLDAS中花费≥50%的时间，并且累积泼尼松龙剂量较低;未观察到损伤累积差异。患者需要超过12个月的时间来实现LLDAS有较高的血小板减少症的患病率和那些与非LLDAS有较低的肾功能和较高的起始剂量的泼尼松龙和类固醇脉冲治疗比那些谁实现LLDAS在12个月内。在高危人群中LLDAS的低发生率强调了SLE治疗新策略的必要性。
ObjectivesTo demonstrate the significance of the time to attain lupus low disease activity state (LLDAS) after remission induction therapy in patients with severely active SLE.MethodsWe enrolled 79 patients starting prednisolone ≥0.4 mg/kg/day for active lupus with a BILAG 2004 index of A ≥ 1 or B ≥ 2, or for severe flare based on the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI). The time to LLDAS attainment was divided into ≤6, 6–12 and >12 months and non-LLDAS; associations between the timing of LLDAS and flares, damage accrual and ≥50% LLDAS attainment were examined.ResultsThe mean SLEDAI was 17; median starting dose of prednisolone, 0.95 mg/kg/day; and mean observational period, 39.7 months. Six (7.6%) and 41 (51.9%) patients achieved LLDAS within 6 and 12 months. Patients with a shorter time to LLDAS achievement were more likely to spend ≥50% of the time in LLDAS and had a lower cumulative prednisolone dose; no differences were observed in damage accrual. Patients requiring longer than 12 months to achieve LLDAS had a higher prevalence of thrombocytopenia and those with non-LLDAS had lower renal function and a higher starting dose of prednisolone and steroid pulse therapy than those who achieved LLDAS within 12 months.ConclusionAchieving LLDAS within 12 months of induction therapy may be favourable in patients with severely active SLE. The low frequency of LLDAS attainment in high-risk populations highlights the need for a new strategy for SLE treatment.