High frequency of corticosteroid and immunosuppressive therapy in patients with systemic sclerosis despite limited evidence for efficacy.
High frequency of corticosteroid and immunosuppressive therapy in patients with systemic sclerosis despite limited evidence for efficacy.
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DOI：
10.1186/ar2634
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发表时间：
2009
影响因子：
4.9
通讯作者：
German Network for Systemic Scleroderma Centers
中科院分区：
文献类型：
--
作者：
Hunzelmann N;Moinzadeh P;Genth E;Krieg T;Lehmacher W;Melchers I;Meurer M;Müller-Ladner U;Olski TM;Pfeiffer C;Riemekasten G;Schulze-Lohoff E;Sunderkoetter C;Weber M;German Network for Systemic Scleroderma Centers
在系统性硬化症（SSc）中，抗炎和免疫抑制治疗的有效性证据很少。本研究的目的是确定SSc患者接受皮质类固醇和免疫抑制剂治疗的程度。分析了在德国系统性硬皮病网络（DNSS）登记的1,729例患者的皮质类固醇持续时间和剂量以及免疫抑制剂类型的数据。在所有登记的SSc患者中，共有41.3%接受了皮质类固醇治疗。49.1%的弥漫性皮肤SSc患者和31.3%的局限性皮肤SSc患者报告使用皮质类固醇（P < 0.0001）。在具有重叠疾病特征的患者中，63.5%接受皮质类固醇（P < 0.0001 vs.局限性皮肤SSc）。共有16.1%的患者接受皮质类固醇，每日剂量≥ 15 mg泼尼松当量。35.8%的患者接受免疫抑制治疗。同样，在有重叠症状的患者中，接受免疫抑制剂治疗的比例（64.1%）要高得多，而弥漫性皮肤SSc硬化患者为46.4%，局限性皮肤SSc患者为22.2%（P < 0.0001）。最常见的处方药物为甲氨蝶呤（30.5%）、环磷酰胺（22.2%）、硫唑嘌呤（21.8%）和（羟基）氯喹（7.2%）。这些化合物的使用在医学亚专业之间差异很大。尽管皮质类固醇和免疫抑制剂在SSc中的有效性的证据有限，但这些潜在有害的药物经常被处方给所有形式的SSc患者。因此，这项研究表明，需要制定和沟通适当的治疗建议。
In systemic sclerosis (SSc) little evidence for the effectiveness of anti-inflammatory and immunosuppressive therapy exists. The objective of this study was to determine the extent to which SSc patients are treated with corticosteroids and immunosuppressive agents. Data on duration and dosage of corticosteroids and on the type of immunosuppressive agent were analyzed from 1,729 patients who were registered in the German Network for Systemic Scleroderma (DNSS). A total 41.3% of all registered SSc patients was treated with corticosteroids. Corticosteroid use was reported in 49.1% of patients with diffuse cutaneous SSc and 31.3% of patients with limited cutaneous SSc (P < 0.0001). Among patients with overlap disease characteristics, 63.5% received corticosteroids (P < 0.0001 vs. limited cutaneous SSc). A total 16.1% of the patients received corticosteroids with a daily dose ≥ 15 mg prednisone equivalent. Immunosuppressive therapy was prescribed in 35.8% of patients. Again, among those patients with overlap symptoms, a much higher proportion (64.1%) was treated with immunosuppressive agents, compared with 46.4% of those with diffuse cutaneous SSc sclerosis and 22.2% of those with limited cutaneous SSc (P < 0.0001). The most commonly prescribed drugs were methotrexate (30.5%), cyclophosphamide (22.2%), azathioprine (21.8%) and (hydroxy)chloroquine (7.2%). The use of these compounds varied significantly between medical subspecialties. Despite limited evidence for the effectiveness of corticosteroids and immunosuppressive agents in SSc, these potentially harmful drugs are frequently prescribed to patients with all forms of SSc. Therefore, this study indicates the need to develop and communicate adequate treatment recommendations.
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影响因子：
39.2
作者：
Steen, VD;Medsger, TA
通讯作者：
Medsger, TA
影响因子：
39.2
作者：
White, B;Moore, WC;Wise, RA
通讯作者：
Wise, RA
影响因子：
158.5
作者：
Tashkin, Donald P.;Elashoff, Robert;Metersky, Mark
通讯作者：
Metersky, Mark
影响因子：
5.2
作者：
Alarcón, GS
通讯作者：
Alarcón, GS
DOI：
10.1093/rheumatology/ken179
发表时间：
2008-08
期刊：
Rheumatology (Oxford, England)
影响因子：
--
作者：
Hunzelmann N;Genth E;Krieg T;Lehmacher W;Melchers I;Meurer M;Moinzadeh P;Müller-Ladner U;Pfeiffer C;Riemekasten G;Schulze-Lohoff E;Sunderkoetter C;Weber M;Worm M;Klaus P;Rubbert A;Steinbrink K;Grundt B;Hein R;Scharffetter-Kochanek K;Hinrichs R;Walker K;Szeimies RM;Karrer S;Müller A;Seitz C;Schmidt E;Lehmann P;Foeldvári I;Reichenberger F;Gross WL;Kuhn A;Haust M;Reich K;Böhm M;Saar P;Fierlbeck G;Kötter I;Lorenz HM;Blank N;Gräfenstein K;Juche A;Aberer E;Bali G;Fiehn C;Stadler R;Bartels V;Registry of the German Network for Systemic Scleroderma
通讯作者：
Registry of the German Network for Systemic Scleroderma