在SLE缓解期患者中,取消低剂量葡萄糖皮质类药物是否安全?
Alexis Mathian1, Laurent Arnaud2, Guillermo Ruiz-Irastorza3
1Assistance Publique-Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Service de Médecine Interne 2, Institut E3M, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.
Autoimmunity reviews
|September 8, 2023
概括
在全身性红斑狼 (SLE) 中停止使用葡萄糖皮质类药物 (GCs) 可能会减少长期损伤. 然而,由于潜在的爆发和替代疗法的风险,仔细个性化治疗至关重要.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 葡萄糖皮质类药物 (GCs) 对于系统性红斑狼 (SLE) 治疗至关重要,但会带来损害累积的风险.
- 精确的机制和有益与有害的GC效应在SLE中的平衡仍然不清楚.
- 由于疾病爆发和相关并发症的风险,在SLE中停止使用GC具有挑战性.
研究的目的:
- 审查在SLE患者中逐渐减少和停止葡萄糖皮质醇治疗的可行性,可取性和潜在风险.
- 评估目前关于低剂量GC对SLE损伤累积的长期影响的证据.
- 确定需要方法来预测哪些SLE患者需要持续低剂量GC治疗.
主要方法:
- 关于葡萄糖皮质激素的使用,戒断和系统性红斑狼的结果现有研究的文献综述.
- 对GC剂量,SLE爆发和器官损伤之间的关联数据的分析.
- 检查来自随机试验和关于GC逐渐减少和停止治疗的观察性研究的发现.
主要成果:
- 虽然低剂量的GC (例如,5毫克的普雷尼松) 可能会在一些SLE患者中预防发作,但它们的长期必要性仍在争论中.
- 在观察性研究中,停用GC与减少损害累积有关.
- 目前的方法不足以可靠地识别需要长期低剂量GC的SLE患者.
结论:
- 在考虑在SLE中停用GC时,个性化评估至关重要,平衡潜在的长期损害减少与爆发风险.
- 需要进行进一步的研究,以确定患有复发高风险的SLE患者,他们可能会从持续低剂量普得尼松中受益.
- 替代性免疫抑制剂和氧化 (HCQ) 也存在风险,必须在治疗决策中考虑这些风险.
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