Ioana Ruiz-Arruza1, Jesús Lozano2, Ivan Cabezas-Rodriguez3, Jose-Alejandro Medina4, Amaia Ugarte1, José-Gabriel Erdozain1, Guillermo Ruiz-Irastorza1. 1. Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, The Basque Country, Spain. 2. Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, The Basque Country, and Hospital Universitario J. M. Morales Meseguer, Murcia, Spain. 3. Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, The Basque Country, and Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. 4. Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, The Basque Country, and Complejo Hospitalario Universitario Nuestra Sra. de Candelaria, S/C de Tenerife, Spain.
Abstract
OBJECTIVE: To analyze the influence of 2 different treatment strategies on general and specific damage accrual in patients with systemic lupus erythematosus (SLE). METHODS: Two cohorts were identified according to the responsible physicians: patients treated at the autoimmune diseases unit (ADU), and patients treated by other members of the internal medicine (IM) department. Members of the ADU worked with a protocol including the universal prescription of hydroxychloroquine (HCQ), the use of maximum oral prednisone dosages ≤30 mg/day and maintenance therapy with ≤5 mg/day, by using methylprednisolone pulses and/or early immunosuppressive (IS) drugs. We analyzed the influence of these 2 treatment strategies on damage accrual, both general and domain specific, attributed to glucocorticoids, cardiovascular (CV) disease, SLE, and unclassified, since the diagnosis of disease in patients with a followup ≥5 years. RESULTS: A total of 74 patients were included in the ADU group and 213 in the IM group. They were comparable for most demographic and lupus-related variables. ADU patients received prednisone later and at lower doses, more methylprednisolone pulses, earlier IS drugs and more HCQ (P < 0.05 for all comparisons). The Systemic Lupus Erythematosus Disease Activity Index score decreased similarly in both cohorts (P = 0.4). Patients in the ADU group were less likely to accrue any damage (P = 0.007). They accrued less glucocorticoid-related (adjusted hazard ratio [HR] 0.23 [95% confidence interval (95% CI) 0.07-0.80]), CV disease (adjusted HR 0.28 [95% CI 0.08-0.95]), and unclassified damage (adjusted HR 0.58 [95% CI 0.3-1.1]). Both groups accrued similar SLE-related damage (adjusted HR 0.84 [95% CI 0.40-1.75]). CONCLUSION: The use of reduced oral prednisone doses, which was possible by combining different therapies, reduced glucocorticoid-related damage and improved CV prognosis without increasing damage caused by SLE.
OBJECTIVE: To analyze the influence of 2 different treatment strategies on general and specific damage accrual in patients with systemic lupus erythematosus (SLE). METHODS: Two cohorts were identified according to the responsible physicians: patients treated at the autoimmune diseases unit (ADU), and patients treated by other members of the internal medicine (IM) department. Members of the ADU worked with a protocol including the universal prescription of hydroxychloroquine (HCQ), the use of maximum oral prednisone dosages ≤30 mg/day and maintenance therapy with ≤5 mg/day, by using methylprednisolone pulses and/or early immunosuppressive (IS) drugs. We analyzed the influence of these 2 treatment strategies on damage accrual, both general and domain specific, attributed to glucocorticoids, cardiovascular (CV) disease, SLE, and unclassified, since the diagnosis of disease in patients with a followup ≥5 years. RESULTS: A total of 74 patients were included in the ADU group and 213 in the IM group. They were comparable for most demographic and lupus-related variables. ADUpatients received prednisone later and at lower doses, more methylprednisolone pulses, earlier IS drugs and more HCQ (P < 0.05 for all comparisons). The Systemic Lupus Erythematosus Disease Activity Index score decreased similarly in both cohorts (P = 0.4). Patients in the ADU group were less likely to accrue any damage (P = 0.007). They accrued less glucocorticoid-related (adjusted hazard ratio [HR] 0.23 [95% confidence interval (95% CI) 0.07-0.80]), CV disease (adjusted HR 0.28 [95% CI 0.08-0.95]), and unclassified damage (adjusted HR 0.58 [95% CI 0.3-1.1]). Both groups accrued similar SLE-related damage (adjusted HR 0.84 [95% CI 0.40-1.75]). CONCLUSION: The use of reduced oral prednisone doses, which was possible by combining different therapies, reduced glucocorticoid-related damage and improved CV prognosis without increasing damage caused by SLE.
Authors: Chiara Tani; Elena Elefante; Viola Signorini; Dina Zucchi; Valentina Lorenzoni; Linda Carli; Chiara Stagnaro; Francesco Ferro; Marta Mosca Journal: RMD Open Date: 2019-06-11
Authors: Manuel Francisco Ugarte-Gil; Anselm Mak; Joanna Leong; Bhushan Dharmadhikari; Nien Yee Kow; Cristina Reátegui-Sokolova; Claudia Elera-Fitzcarrald; Cinthia Aranow; Laurent Arnaud; Anca D Askanase; Sang-Cheol Bae; Sasha Bernatsky; Ian N Bruce; Jill Buyon; Nathalie Costedoat-Chalumeau; Mary Ann Dooley; Paul R Fortin; Ellen M Ginzler; Dafna D Gladman; John Hanly; Murat Inanc; David Isenberg; Soren Jacobsen; Judith A James; Andreas Jönsen; Kenneth Kalunian; Diane L Kamen; Sung Sam Lim; Eric Morand; Marta Mosca; Christine Peschken; Bernardo A Pons-Estel; Anisur Rahman; Rosalind Ramsey-Goldman; John Reynolds; Juanita Romero-Diaz; Guillermo Ruiz-Irastorza; Jorge Sánchez-Guerrero; Elisabet Svenungsson; Murray Urowitz; Evelyne Vinet; Ronald F van Vollenhoven; Alexandre Voskuyl; Daniel J Wallace; Michelle A Petri; Susan Manzi; Ann Elaine Clarke; Mike Cheung; Vernon Farewell; Graciela S Alarcon Journal: Lupus Sci Med Date: 2021-12
Authors: Víctor Moreno-Torres; Carlos Tarín; Guillermo Ruiz-Irastorza; Raquel Castejón; Ángela Gutiérrez-Rojas; Ana Royuela; Pedro Durán-Del Campo; Susana Mellor-Pita; Pablo Tutor; Silvia Rosado; Enrique Sánchez; María Martínez-Urbistondo; Carmen de Mendoza; Miguel Yebra; Juan-Antonio Vargas Journal: J Clin Med Date: 2021-12-08 Impact factor: 4.241