Possibilities and prospects for glucocorticoid withdrawal in systemic lupus erythematosus
https://doi.org/10.14412/1996-7012-2020-1-6-11
Abstract
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.
About the Authors
S. K. Solovyev
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
E. A. Aseeva
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
E. L. Nasonov
V.A. Nasonova Research Institute of Rheumatology;
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
Russian Federation
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522;
Departament of Internal and Occupational Diseases and Rheumatology, 8, Trubetskaya St., Build. 2, Moscow 119991
A. M. Lila
V.A. Nasonova Research Institute of Rheumatology;
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522;
Department of Rheumatology, 2/1, Barrikadnaya St., Build. 1, Moscow 125993
G. M. Koilubaeva
Academician Mirsaid Mirrakhimov National Center of Cardiology and Therapy
Kyrgyzstan
3, Togolok Moldo, Bishkek 720040
Kyrgyzstan
3, Togolok Moldo, Bishkek 720040
References
1. Nasonov EL. Revmatologiya. Rossiyskie klinicheskie rekomendatsii [Rheumatology. Russian clinical guidelines]. Moscow: GEOTAR-Media; 2017 (In Russ.).
2. 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.1952.02930280024007
3. Mosca M, Tani C, Carli L, et al. Glucocorticoids in systemic lupus erythematosus. Clin Exp Rheumatol. 2011;29 (5 Suppl 68):S126-9.
4. 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.
5. 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-O
6. Dixon 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-2011-200702
7. Bruce 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/kei142
8. Bhangle 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-z
9. Carter 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.2016.137
10. Barber MRW, Clarke AE. Socioeconomic consequences of systemic lupus erythematosus. Curr Opin Rheumatol. 2017 Sep;29(5):480-5. doi: 10.1097/BOR.0000000000000416
11. Durcan 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)30237-5
12. Dö rner T, Furie R. Novel paradigms in systemic lupus erythematosus. Lancet. 2019;393:2344-58. doi: 10.1016/S0140-6736(19)30546-X
13. Van 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/annrheumdis2013-205139
14. 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.).
15. 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.
16. 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/gfk073
17. Moroni 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.2017.11.003
18. 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.
19. 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-2012-201940
20. Van 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-2016-209519
21. Ngamjanyaporn 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-2016-000173
22. Tani 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/rmdopen2019-000916
23. Franklyn 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-2015-207726
24. 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.).
25. Zen M, Gatto M, Nalotto L, et al. The management of systemic lupus Erythematosus (SLE) patients in Remission. IMAJ. 2017;19:454-8.
26. 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.131137
27. Medeiros 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: 10.1177/0961203315606983
28. Urowitz MB, Feletar M, Bruce IN, et al. Prolonged remission in systemic lupus erythematosus. J Rheumatol. 2005 Aug;32(8): 1467-72.
29. 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-2012-202844
30. Markowitz 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.5002118
31. Gracia-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
Review
For citations:
Solovyev SK, Aseeva EA, Nasonov EL, Lila AM, Koilubaeva GM. Possibilities and prospects for glucocorticoid withdrawal in systemic lupus erythematosus. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2020;14(1):6-11. (In Russ.) https://doi.org/10.14412/1996-7012-2020-1-6-11
Views:
1321
Email this article 