Prevalence of remission and its effect on damage and quality of life in Chinese patients with systemic lupus erythematosus

Mok, Chi Chiu; Ho, Ling Yin; Tse, Sau Mei; Chan, Kar Li

doi:10.1136/annrheumdis-2016-210382

Cited by 75 publications

(82 citation statements)

References 25 publications

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“…However, there is some indirect data that underscore the importance of low-dose GCs for maintaining clinical quiescence. Indeed, it is well known that prolonged complete remission defined by the absence of clinical activity with no use of GCs and immunosuppressant is infrequent in SLE ranging from 2% to 32% 11 17 23 25–27…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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ObjectivesTo 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.MethodsA 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-SLEDAI 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).ResultsProportion 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.ConclusionMaintenance of long term 5 mg prednisone in SLE patients with inactive disease prevents relapse.Trial registration numberNCT02558517; Results

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Significant advances accomplished over the past decades in the treatment of SLE have resulted in increased patient survival and reduced rates of end-stage renal disease in cases with kidney involvement 1 2. Nevertheless, management of patients with lupus still remains far from optimal, complete control of disease activity is only infrequently obtained,3–5 while patients considered to be in ‘remission’ by their treating physicians often report a considerable residual symptom burden 6. Persistent disease activity, together with flare-ups and accumulating toxicity from chronic use of glucocorticoids (GC) and immunosuppressive (IS) drugs, all contribute to the risk of progressive irreversible damage accrual, the latter ultimately associated with reduced survival 7 8…”

Section: Unmet Needs In the Management Of Slementioning

confidence: 99%

Changing paradigms in the treatment of systemic lupus erythematosus

Fanouriakis

Βertsias

2019

Lupus Sci Med

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SLE poses formidable therapeutic challenges due to its heterogeneity and treatment decisions often cannot be guided by data of high quality. In this review, we attempt to provide insights regarding the treatment of SLE in everyday clinical practice, based on contemporary evidence and our own personal experience. We focus on common therapeutic issues and dilemmas arising in routine care, including monitoring for retinal toxicity associated with hydroxychloroquine, handling of glucocorticoid regimens in order to minimise their adverse events, choice of immunosuppressive medications based on prevailing disease manifestations and optimal use of available biological agents (belimumab and rituximab). We also provide our view on the position of calcineurin inhibitors in the management of lupus nephritis and conclude with remarks on the future perspectives for this challenging disease.

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“…22 The major self-reported symptoms that lead to impaired quality of life are problems with memory and concentration and symptoms of anxiety and depression. 23 Therefore, patients with SLE should receive education about the disease, psychological counselling, and support in the primary care setting.…”

Section: Role Of Family Physiciansmentioning

confidence: 99%

Systemic lupus erythematosus: what should family physicians know in 2018?

Mok

2018

Hong Kong Med J

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Systemic lupus erythematosus (SLE) is a complex multi-systemic autoimmune disease with considerable clinical and immunological heterogeneity. Family physicians should be familiar with the protean manifestations of SLE to aid early diagnosis and monitoring of disease progression. The role of family physicians in SLE includes education, counselling, psychological support, management of mild disease, and recognition of the need for referral to other specialists for more serious disease and complications. Surveillance of cardiovascular risk factors and osteoporosis and advice about vaccination and reproductive issues can be performed in the primary care setting under Systemic lupus erythematosus: what should family physicians know in 2018?

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Prevalence of remission and its effect on damage and quality of life in Chinese patients with systemic lupus erythematosus

Abstract: Durable remission can be achieved in a quarter of patients with SLE. Patients with remission for ≥5 years have significantly less damage accrual and better QOL. Prolonged remission is an appropriate criterion for outcome assessment in SLE.

Cited by 75 publications

References 25 publications

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

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

Changing paradigms in the treatment of systemic lupus erythematosus

Systemic lupus erythematosus: what should family physicians know in 2018?

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