Glucocorticoid, immunosuppressant, hydroxychloroquine monotherapy, or no therapy for maintenance treatment in systemic lupus erythematosus without major organ manifestations
To study maintenance therapy after achievement of the lowest possible disease activity in systemic lupus erythematosus (SLE) without major organ manifestations.
We retrospectively evaluated patients with SLE who visited our hospital from Jan 2015 to Feb 2018 and were taking prednisolone (PSL) < 10 mg/day. After excluding those with neuropsychiatric SLE or severe lupus nephritis, patients were divided into four groups according to their maintenance monotherapy treatment, namely, prednisolone (PSL), immunosuppressant (IS), hydroxychloroquine (HCQ), and no drugs. The groups were then compared with regard to cumulative flare rate and changes in SLE Disease Activity Index (SLEDAI).
There were 47 patients on PSL, 10 on IS, 5 on HCQ, and 11 on no drugs. Flare rate was higher in the no drug group, and no patients with the IS or HCQ group experienced a flare (p = 0.003). A reduction in SLEDAI was only seen in the IS and HCQ groups (p = 0.05 and p = 0.03, respectively). There were no differences in adverse events among groups during the study period.
• Immunosuppressant or hydroxychloroquine monotherapy appears to be a reasonable maintenance strategy.
KeywordsHydroxychloroquine Immunosuppressive agents Relapse Systemic lupus erythematosus
Compliance with ethical standards
This study was approved by the Ethics Committee of St. Marianna University School of Medicine (approval number 3305).
- 1.Gordon C, Amissah-Arthur MB, Gayed M, Brown S, Bruce IN, D’Cruz D, Empson B, Griffiths B, Jayne D, Khamashta M, Lightstone L, Norton P, Norton Y, Schreiber K, Isenberg D, British Society for Rheumatology Standards, Audit and Guidelines Working Group (2018) The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults: executive summary. Rheumatology (Oxford) 57:14–18CrossRefGoogle Scholar
- 2.van Vollenhoven RF, Mosca M, Bertsias G, Isenberg D, Kuhn A, Lerstrøm K, Aringer M, Bootsma H, Boumpas D, Bruce IN, Cervera R, Clarke A, Costedoat-Chalumeau N, Czirják L, Derksen R, Dörner T, Gordon C, Graninger W, Houssiau F, Inanc M, Jacobsen S, Jayne D, Jedryka-Goral A, Levitsky A, Levy R, Mariette X, Morand E, Navarra S, Neumann I, Rahman A, Rovensky J, Smolen J, Vasconcelos C, Voskuyl A, Voss A, Zakharova H, Zoma A, Schneider M (2014) Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis 73:958–967CrossRefGoogle Scholar
- 5.van Vollenhoven R, Voskuyl A, Bertsias G, Aranow C, Aringer M, Arnaud L, Askanase A, Balážová P, Bonfa E, Bootsma H, Boumpas D, Bruce I, Cervera R, Clarke A, Coney C, Costedoat-Chalumeau N, Czirják L, Derksen R, Doria A, Dörner T, Fischer-Betz R, Fritsch-Stork R, Gordon C, Graninger W, Györi N, Houssiau F, Isenberg D, Jacobsen S, Jayne D, Kuhn A, Le Guern V, Lerstrøm K, Levy R, Machado-Ribeiro F, Mariette X, Missaykeh J, Morand E, Mosca M, Inanc M, Navarra S, Neumann I, Olesinska M, Petri M, Rahman A, Rekvig OP, Rovensky J, Shoenfeld Y, Smolen J, Tincani A, Urowitz M, van Leeuw B, Vasconcelos C, Voss A, Werth VP, Zakharova H, Zoma A, Schneider M, Ward M (2017) A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS). Ann Rheum Dis 76:554–551CrossRefGoogle Scholar
- 7.Mosca M, Tani C, Aringer M (2013) Withdrawal of therapy in non-renal systemic lupus erythematosus: is this an achievable goal? Clin Exp Rheumatol 31:S71–S74Google Scholar
- 10.Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M (2004) The classification of glomerulonephritis in systemic lupus erythematosus revised. J Am Soc Nephrol 15:241–250CrossRefGoogle Scholar
- 15.Pons-Estel BA, Catoggio LJ, Cardiel MH, Grupo Latinoamericano de Estudio del Lupus et al (2004) The GLADEL multinational Latin American prospective inception cohort of 1,214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among “Hispanics”. Medicine (Baltimore) 83:1–17CrossRefGoogle Scholar