Safety and efficacy of switching immunosuppressive drugs for maintenance treatment in patients with systemic lupus erythematosus: a retrospective cohort study
Safety and efficacy of switching immunosuppressive drugs for maintenance treatment in patients with systemic lupus erythematosus: a retrospective cohort study
复制标题
系统性红斑狼疮患者换用免疫抑制剂维持治疗的安全性和有效性：一项回顾性队列研究
DOI：
10.1093/mr/roac100
复制
发表时间：
2022
期刊：
影响因子：
2.2
通讯作者：
Niiro H
中科院分区：
文献类型：
--
作者：
Ayano M;Kimoto Y;Mitoma H;Akahoshi M;Ono N;Arinobu Y;Akashi K;Horiuchi T;Niiro H
目的研究系统性红斑狼疮（SLE）患者转换免疫抑制药物的疗效和安全性，并确定转换后治疗失败的预测因素。方法回顾性评估2015年至2020年间在我院因任何原因改用免疫抑制药物的SLE患者。疗效终点是SLE疾病活动指数2000评分的变化、强的松龙剂量、12个月的疾病状态以及治疗持续率。安全性终点是切换前后1年内不良事件发生的频率。采用Cox风险回归分析确定治疗失败的预测因素。结果本组患者39例，年龄41.5±12.6岁，女35例，男4例。转换后SLE疾病活动指数评分和泼尼松龙剂量显著降低，在12个月内几乎没有疾病恶化。1年和2年的延续率分别为71.4%和62.3%。换药前后一年不良事件发生频率相似。由于疗效不足而转换药物是治疗失败可能性较小的预测因素。结论免疫抑制药物转换导致疾病活动性降低，糖皮质激素剂量降低，无疾病加重和严重不良事件。
ObjectivesWe aim to clarify the efficacy and safety of switching immunosuppressive drugs and to identify the predictive factors for treatment failure after switching in patients with systemic lupus erythematosus (SLE).MethodsWe retrospectively evaluated patients with SLE who switched immunosuppressive drugs for any reason in our hospital between 2015 and 2020. The efficacy endpoints were the change in SLE Disease Activity Index 2000 score, prednisolone dose, and disease status over 12 months, as well as treatment continuation rates. The safety endpoint was the frequency of adverse events over 1 year before and after switching. Cox hazard regression analyses were used to identify the predictive factors for treatment failure.ResultsThirty-nine patients (age, 41.5 ± 12.6 years; 35 women and 4 men) were analysed. The SLE Disease Activity Index score and prednisolone dose were significantly reduced after switching, with few disease exacerbations over 12 months. The 1- and 2-year continuation rates were 71.4% and 62.3%, respectively. The frequency of adverse events was similar in the year before and after switching the drug. Drug switching due to inadequate efficacy was a predictive factor of less likely treatment failure.ConclusionsImmunosuppressive drug switching led to reduced disease activity and decreased glucocorticoid dose without disease exacerbations and severe adverse events.