Withdrawal of low-dose prednisone in SLE patients with a clinically quiescent disease for more than 1 year: a randomised clinical trial

被引:129
作者
Mathian, Alexis [1 ]
Pha, Micheline [1 ]
Haroche, Julien [1 ]
Cohen-Aubart, Fleur [1 ]
Hie, Miguel [1 ]
de Chambrun, Marc Pineton [1 ]
Du Boutin, Thi Huong [1 ]
Miyara, Makoto [2 ]
Gorochov, Guy [2 ]
Yssel, Hans [2 ]
Cherin, Patrick [1 ]
Devilliers, Herve [3 ,4 ]
Amoura, Zahir [1 ]
机构
[1] Sorbonne Univ, Grp Hosp Pitie Salpetriere,Serv Med Interne 2, AP HP,Natl Referral Ctr Syst Lupus Erythematosus, Inst E3M,UMRS,Ctr Immunol & Malad Infect CIMI Par, Paris, France
[2] Sorbonne Univ, Grp Hosp Pitie Salpetriere, AP HP,Dept Immunol, INSERM,UMR S,Ctr Immunol & Malad Infect CIMI Pari, Paris, France
[3] CHU Dijon, Hop Francois Mitterrand, Serv Med Interne & Malad Syst Med Interne 2, Dijon, France
[4] INSERM, CIC, EC 1432, Dijon, France
关键词
SYSTEMIC-LUPUS-ERYTHEMATOSUS; QUALITY-OF-LIFE; PROLONGED REMISSION; INITIAL VALIDATION; BILAG; 2004; DAMAGE; RECOMMENDATIONS; INDEX; GLUCOCORTICOIDS; ASSOCIATION;
D O I
10.1136/annrheumdis-2019-216303
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives To compare the efficacy to prevent flares of maintenance versus withdrawal of 5 mg/day prednisone in systemic lupus erythematosus (SLE) patients with clinically quiescent disease. Methods A monocentric, 12-month, superiority, open-label, randomised (1:1) controlled trial was conducted with 61 patients continuing 5 mg/day prednisone and 63 stopping it. Eligibility criteria were SLE patients who, during the year preceding the inclusion, had a clinically inactive disease and a stable SLE treatment including 5 mg/day prednisone. The primary endpoint was the proportion of patient experiencing a flare defined with the SELENA-SLE DAI flare index (SFI) at 52 weeks. Secondary endpoints included time to flare, flare severity according to SFI and British Isles Lupus Assessment Group (BILAG) index and increase in the Systemic Lupus International Collaborating Clinics (SLICC) damage index (SDI). Results Proportion of patients experiencing a flare was significantly lower in the maintenance group as compared with the withdrawal group (4 patients vs 17; RR 0.2 (95% CI 0.1 to 0.7), p=0.003). Maintenance of 5 mg prednisone was superior with respect to time to first flare (HR 0.2; 95% CI 0.1 to 0.6, p=0.002), occurrence of mild/moderate flares using the SFI (3 patients vs 12; RR 0.2 (95% CI 0.1 to 0.8), p=0.012) and occurrence of moderate/severe flares using the BILAG index (1 patient vs 8; RR 0.1 (95% CI 0.1 to 0.9), p=0.013). SDI increase and adverse events were similar in the two treatment groups. Subgroup analyses of the primary endpoint by predefined baseline characteristics did not show evidence of a different clinical response. Conclusion Maintenance of long term 5 mg prednisone in SLE patients with inactive disease prevents relapse.
引用
收藏
页码:339 / 346
页数:8
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