mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2020-1-6-11mrj-986Research ArticleЛЕКЦИЯLECTUREВозможности и перспективы отмены глюкокортикоидов при системной красной волчанкеPossibilities and prospects for glucocorticoid withdrawal in systemic lupus erythematosusСоловьевС. К.SolovyevS. K.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

sksoloviev@mail.ruАсееваЕ. А.AseevaE. A.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

НасоновЕ. Л.NasonovE. L.

115522, Москва, Каширское шоссе, 34А;

кафедра внутренних, профессиональных болезней и ревматологии, 119991, Москва, ул. Трубецкая, 8, стр. 2

34A, Kashirskoe Shosse, Moscow 115522;

Departament of Internal and Occupational Diseases and Rheumatology, 8, Trubetskaya St., Build. 2, Moscow 119991

ЛилаА. М.LilaA. M.

115522, Москва, Каширское шоссе, 34А;

кафедра ревматологии, 125993, Москва, ул. Баррикадная, 2/1, стр. 1

34A, Kashirskoe Shosse, Moscow 115522;

Department of Rheumatology, 2/1, Barrikadnaya St., Build. 1, Moscow 125993

КойлубаеваГ. М.KoilubaevaG. M.

720040, Бишкек, ул. Тоголока Молдо, 3

3, Togolok Moldo, Bishkek 720040

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияV.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)Russian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaRussian FederationНациональный Центр кардиологии и терапии имени академика Мирсаида МиррахимоваКыргызстанAcademician Mirsaid Mirrakhimov National Center of Cardiology and TherapyKyrgyzstan202020032020141611Copyright © Соловьев С.К., Асеева Е.А., Насонов Е.Л., Лила А.М., Койлубаева Г.М., 20202020Соловьев С.К., Асеева Е.А., Насонов Е.Л., Лила А.М., Койлубаева Г.М.Solovyev S.K., Aseeva E.A., Nasonov E.L., Lila A.M., Koilubaeva G.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/986

Эффективность терапии системной красной волчанки (СКВ) глюкокортикоидами (ГК) не вызывает сомнений и подтверждена опытом, накопленным за многие десятилетия их применения. Однако при длительном использовании ГК даже в низких и средних дозах существует немало проблем. В частности, развитие необратимых органных повреждений, ассоциированных с ГК, значительно ухудшает прогноз, приводит к снижению качества жизни, социальной адаптации и существенному удорожанию лечения. С другой стороны, использование современных возможностей ранней диагностики, патогенетической терапии и мониторинга у многих пациентов с СКВ позволяет поддерживать низкую активность и ремиссию – состояния, при которых можно и нужно решать вопрос о целесообразности дальнейшей терапии ГК. В статье приводятся данные литературы и собственных исследований о возможности и перспективах отмены ГК у больных СКВ в стадии низкой активности и ремиссии.

The efficiency of glucocorticoid (GC) therapy for systemic lupus erythematosus (SLE) is beyond question and is confirmed by the experience gained over many decades of their use. However, there are many problems with prolonged GC use, even in its low and medium doses. In particular, the development of GC-associated irreversible organ damages significantly worsens prognosis and causes a decrease in quality of life and social adaptation and a substantial increase in treatment costs. On the other hand, the current capabilities of early diagnosis, pathogenetic therapy, and monitoring in many patients with SLE allow for maintaining low disease activity and remission, the conditions in which the feasibility of further GC treatment can and should be decided. The paper gives the data available in the literature and the authors’ own studies on the possibility and prospects of GC withdrawal in SLE patients in a stage of low disease activity and remission.

системная красная волчанкаглюкокортикоидынеобратимые органные повреждениягенно-инженерные биологические препаратыsystemic lupus erythematosusglucocorticoidsirreversible organ damagesbiological agentsReferencesНасонов ЕЛ. Ревматология. Российские клинические рекомендации. Москва: ГЭОТАР-Медиа; 2017.Nasonov EL. Revmatologiya. Rossiyskie klinicheskie rekomendatsii [Rheumatology. Russian clinical guidelines]. Moscow: GEOTAR-Media; 2017 (In Russ.).Soffer LJ, Barder R. Corticotropin and cortisone in acute disseminated lupus erythematosus; results of long-term use. J Am Med Assoc. 1952 Jul 12;149(11):1002-8. doi: 10.1001/jama.1952.02930280024007Soffer LJ, Barder R. Corticotropin and cortisone in acute disseminated lupus erythematosus; results of long-term use. J Am Med Assoc. 1952 Jul 12;149(11):1002-8. doi: 10.1001/jama.1952.02930280024007Mosca M, Tani C, Carli L, et al. Glucocorticoids in systemic lupus erythematosus. Clin Exp Rheumatol. 2011;29 (5 Suppl 68):S126-9.Mosca M, Tani C, Carli L, et al. Glucocorticoids in systemic lupus erythematosus. Clin Exp Rheumatol. 2011;29 (5 Suppl 68):S126-9.Gladman DD, Urowitz MB, Rahman P, et al. Accrual of organ damage over time in patients with systemic lupus erythematosus. J Rheumatol. 2003;30:1955-9.Gladman DD, Urowitz MB, Rahman P, et al. Accrual of organ damage over time in patients with systemic lupus erythematosus. J Rheumatol. 2003;30:1955-9.Zonana-Nacach A, Barr SG, Magder LS, et al. Damage in systemic lupus erythematosus and its association with corticosteroids. Arthritis Rheum. 2000;43:1801-8. doi: 10.1002/1529-0131(200008)43:83.0.CO;2-OZonana-Nacach A, Barr SG, Magder LS, et al. Damage in systemic lupus erythematosus and its association with corticosteroids. Arthritis Rheum. 2000;43:1801-8. doi: 10.1002/1529-0131(200008)43:83.0.CO;2-ODixon WG, Abrahamowicz M, Beauchamp M-E, et al. Immediate and delayed impact of oral glucocorticoid therapy on risk of serious infection in older patients with rheumatoid arthritis: a nested case-control analysis. Ann Rheum Dis. 2012;71: 1128-33. doi: 10.1136/annrheumdis-2011-200702Dixon WG, Abrahamowicz M, Beauchamp M-E, et al. Immediate and delayed impact of oral glucocorticoid therapy on risk of serious infection in older patients with rheumatoid arthritis: a nested case-control analysis. Ann Rheum Dis. 2012;71: 1128-33. doi: 10.1136/annrheumdis-2011-200702Bruce IN. 'Not only… but also': factors that contribute to accelerated atherosclerosis and premature coronary heart disease in systemic lupus erythematosus. Rheumatology. 2005;44: 1492-502. doi: 10.1093/rheumatology/kei142Bruce IN. 'Not only… but also': factors that contribute to accelerated atherosclerosis and premature coronary heart disease in systemic lupus erythematosus. Rheumatology. 2005;44: 1492-502. doi: 10.1093/rheumatology/kei142Bhangle SD, Kramer N, Rosenstein ED. Corticosteroid-induced neuropsychiatric disorders: review and contrast with neuropsychiatric lupus. Rheumatol Int. 2013;33:1923-32. doi: 10.1007/s00296-013-2750-zBhangle SD, Kramer N, Rosenstein ED. Corticosteroid-induced neuropsychiatric disorders: review and contrast with neuropsychiatric lupus. Rheumatol Int. 2013;33:1923-32. doi: 10.1007/s00296-013-2750-zCarter EE, Barr SG, Clarke AE. The global burden of SLE: prevalence, health disparities and socioeconomic impact. Nat Rev Rheumatol. 2016 Oct;12(10):605-20. doi: 10.1038/nrrheum.2016.137Carter EE, Barr SG, Clarke AE. The global burden of SLE: prevalence, health disparities and socioeconomic impact. Nat Rev Rheumatol. 2016 Oct;12(10):605-20. doi: 10.1038/nrrheum.2016.137Barber MRW, Clarke AE. Socioeconomic consequences of systemic lupus erythematosus. Curr Opin Rheumatol. 2017 Sep;29(5):480-5. doi: 10.1097/BOR.0000000000000416Barber MRW, Clarke AE. Socioeconomic consequences of systemic lupus erythematosus. Curr Opin Rheumatol. 2017 Sep;29(5):480-5. doi: 10.1097/BOR.0000000000000416Durcan L, O’Dwyer T, Petri M. Management strategies and future directions for systemic lupus erythematosus in adults. Lancet. 2019 Jun 8;393(10188):2332-43. doi: 10.1016/S0140-6736(19)30237-5Durcan L, O’Dwyer T, Petri M. Management strategies and future directions for systemic lupus erythematosus in adults. Lancet. 2019 Jun 8;393(10188):2332-43. doi: 10.1016/S0140-6736(19)30237-5Dö rner T, Furie R. Novel paradigms in systemic lupus erythematosus. Lancet. 2019;393:2344-58. doi: 10.1016/S0140-6736(19)30546-XDö rner T, Furie R. Novel paradigms in systemic lupus erythematosus. Lancet. 2019;393:2344-58. doi: 10.1016/S0140-6736(19)30546-XVan Vollenhoven RF, Mosca M, Bertsias G, et al. Treat-to-target in systemic lupus rythematosus: recommendations from an international Task Force. Ann Rheum Dis. 2014;73:958-67. doi: 10.1136/annrheumdis2013-205139Van Vollenhoven RF, Mosca M, Bertsias G, et al. Treat-to-target in systemic lupus rythematosus: recommendations from an international Task Force. Ann Rheum Dis. 2014;73:958-67. doi: 10.1136/annrheumdis2013-205139Соловьев СК, Асеева ЕА, Зоткин ЕГ и др. Проблемы низкой активности и ремиссии при системной красной волчанке Научно-практическая ревматология. 2019; 57(2):218-21. doi: 10.14412/1995-4484-2019-218-221.Soloviev SK, Aseeva EA, Zotkin EG, et al. Problems of low activity and remission in systemic lupus erythematosus. NauchnoPrakticheskaya Revmatologiya = Rheumatology Science and Practice. 2019;57(2):218-21. doi: 10.14412/1995-4484-2019-218-221 (In Russ.).Moroni G, Longhi S, Giglio E, et al. What happens after complete withdrawal of therapy in patients with lupus nephritis. Clin Exp Rheumatol. 2013;31:S75-81.Moroni G, Longhi S, Giglio E, et al. What happens after complete withdrawal of therapy in patients with lupus nephritis. Clin Exp Rheumatol. 2013;31:S75-81.Moroni G, Gallelli B, Quaglini S, et al. Withdrawal of therapy in patients with proliferative lupus nephritis: long-term follow-up. Nephrol Dial Transplant. 2006;21:1541-8. doi: 10.1093/ndt/gfk073Moroni G, Gallelli B, Quaglini S, et al. Withdrawal of therapy in patients with proliferative lupus nephritis: long-term follow-up. Nephrol Dial Transplant. 2006;21:1541-8. doi: 10.1093/ndt/gfk073Moroni G, Gatto M, Raffiotta F, et al. Can we withdraw immunosuppressants in patients with lupus nephritis in remission? an expert debate. Autoimmun Rev. 2018;17:11-8. doi: 10.1016/j.autrev.2017.11.003Moroni G, Gatto M, Raffiotta F, et al. Can we withdraw immunosuppressants in patients with lupus nephritis in remission? an expert debate. Autoimmun Rev. 2018;17:11-8. doi: 10.1016/j.autrev.2017.11.003Mosca M, Tani C, Aringer M. Withdrawal of therapy in non-renal systemic lupus erythematosus: is this an achievable goal? Clin Exp Rheumatol. 2013;31(4 Suppl 78):S71-4.Mosca M, Tani C, Aringer M. Withdrawal of therapy in non-renal systemic lupus erythematosus: is this an achievable goal? Clin Exp Rheumatol. 2013;31(4 Suppl 78):S71-4.Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League against rheumatism and European renal Association – European dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71:1771-82. doi: 10.1136/annrheumdis-2012-201940Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League against rheumatism and European renal Association – European dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71:1771-82. doi: 10.1136/annrheumdis-2012-201940Van Vollenhoven R, Voskuyl A, Bertsias G, et al. A framework for remission in SLE: consensus findings from a large international Task Force on definitions of remission in SLE (DORIS). Ann Rheum Dis. 2017;76:554-61. doi: 10.1136/annrheumdis-2016-209519Van Vollenhoven R, Voskuyl A, Bertsias G, et al. A framework for remission in SLE: consensus findings from a large international Task Force on definitions of remission in SLE (DORIS). Ann Rheum Dis. 2017;76:554-61. doi: 10.1136/annrheumdis-2016-209519Ngamjanyaporn P, McCarthy EM, Sergeant JC, et al. Clinicians approaches to management of background treatment inpatients with SLE in clinical remission: results of an international observational survey. Lupus Sci Med. 2017;4:e000173. doi: 10.1136/lupus-2016-000173Ngamjanyaporn P, McCarthy EM, Sergeant JC, et al. Clinicians approaches to management of background treatment inpatients with SLE in clinical remission: results of an international observational survey. Lupus Sci Med. 2017;4:e000173. doi: 10.1136/lupus-2016-000173Tani C, Elefante E, Signorini V, et al. Glucocorticoid withdrawal in systemic lupus erythematosus: are remission and low disease activity reliable starting points for stopping treatment? A real-life experience. RMD Open. 2019;5:e000916. doi: 10.1136/rmdopen2019-000916Tani C, Elefante E, Signorini V, et al. Glucocorticoid withdrawal in systemic lupus erythematosus: are remission and low disease activity reliable starting points for stopping treatment? A real-life experience. RMD Open. 2019;5:e000916. doi: 10.1136/rmdopen2019-000916Franklyn K, Lau CS, Navarra SV, et al. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS). Ann Rheum Dis. 2016;75:1615-21. doi: 10.1136/annrheumdis-2015-207726Franklyn K, Lau CS, Navarra SV, et al. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS). Ann Rheum Dis. 2016;75:1615-21. doi: 10.1136/annrheumdis-2015-207726Асеева ЕА, Дубиков АИ, Левашева ЛА и др. Регистр пациентов с системной красной волчанкой, Евразийская когорта (РЕНЕССАНС). Научно-практическая ревматология. 2016;54(5):520-6. doi: 10.14412/1995-4484-2016-520-526.Aseeva EA, Dubikov AI, Levasheva LA, et al. The registry of systemic lupus erythematosus patients, a Eurasian cohort (RENAISSANCE). Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2016;54(5):520-6. doi: 10.14412/1995-4484-2016-520-526 (In Russ.).Zen M, Gatto M, Nalotto L, et al. The management of systemic lupus Erythematosus (SLE) patients in Remission. IMAJ. 2017;19:454-8.Zen M, Gatto M, Nalotto L, et al. The management of systemic lupus Erythematosus (SLE) patients in Remission. IMAJ. 2017;19:454-8.Steiman AJ, Urowitz MB, Ibanez D, et al. Prolonged clinical remission in patients with systemic lupus erythematosus. J Rheumatol. 2014;41(9):1808-16. doi: 10.3899/jrheum.131137Steiman AJ, Urowitz MB, Ibanez D, et al. Prolonged clinical remission in patients with systemic lupus erythematosus. J Rheumatol. 2014;41(9):1808-16. doi: 10.3899/jrheum.131137Medeiros MM, Bezerra MC, Braga FN, et al. Clinical and immunological aspects and outcome of a Brazilian cohort of 414 patients with systemic lupus erythematosus (SLE): comparison between childhood-onset, adultonset, and late-onset SLE. Lupus. 2016; 25(4):355-63. doi: 10.1177/0961203315606983Medeiros MM, Bezerra MC, Braga FN, et al. Clinical and immunological aspects and outcome of a Brazilian cohort of 414 patients with systemic lupus erythematosus (SLE): comparison between childhood-onset, adultonset, and late-onset SLE. Lupus. 2016; 25(4):355-63. doi: 10.1177/0961203315606983Urowitz MB, Feletar M, Bruce IN, et al. Prolonged remission in systemic lupus erythematosus. J Rheumatol. 2005 Aug;32(8): 1467-72.Urowitz MB, Feletar M, Bruce IN, et al. Prolonged remission in systemic lupus erythematosus. J Rheumatol. 2005 Aug;32(8): 1467-72.Condon MB, Ashby D, Pepper RJ, et al. Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids. Ann Rheum Dis. 2013 Aug;72(8):1280-6. doi: 10.1136/annrheumdis-2012-202844Condon MB, Ashby D, Pepper RJ, et al. Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids. Ann Rheum Dis. 2013 Aug;72(8):1280-6. doi: 10.1136/annrheumdis-2012-202844Markowitz GS, D'Agati VD. The ISN/RPS 2003 classification of lupus nephritis: an assessment at 3 years. Kidney Int. 2007 Mar;71(6):491-5. doi: 10.1038/sj.ki.5002118Markowitz GS, D'Agati VD. The ISN/RPS 2003 classification of lupus nephritis: an assessment at 3 years. Kidney Int. 2007 Mar;71(6):491-5. doi: 10.1038/sj.ki.5002118Gracia-Tello B, Ezeonyeji A, Isenberg D. The use of rituximab in newly diagnosed patients with systemic lupus erythematosus: long-term steroid saving capacity and clinical effectiveness. Lupus Sci Med. 2017;4:e000182. doi: 10.1136/lupus-2016-000182Gracia-Tello B, Ezeonyeji A, Isenberg D. The use of rituximab in newly diagnosed patients with systemic lupus erythematosus: long-term steroid saving capacity and clinical effectiveness. Lupus Sci Med. 2017;4:e000182. doi: 10.1136/lupus-2016-000182

The authors declare that there are no conflicts of interest present.