Balancing risks and benefits in the use of hydroxychloroquine and glucocorticoids in systemic lupus erythematosus.

IF 3.9 3区医学 Q2 IMMUNOLOGY

Expert Review of Clinical Immunology Pub Date : 2024-04-01 Epub Date: 2023-12-25 DOI:10.1080/1744666X.2023.2294938

Diana Paredes-Ruiz, Daniel Martin-Iglesias, Guillermo Ruiz-Irastorza

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Abstract

Introduction: Hydroxychloroquine (HCQ) and glucocorticoids (GCs) constitute the oldest and more used drugs in the treatment of systemic lupus erythematosus (SLE). Despite this long experience, both are still subject to a number of uncertainties, mainly regarding the dose.

Areas covered: We review the main mechanisms of action, the clinical and toxic effects of HCQ and GCs and analyze the recommendations for the use of both in guidelines published since 2018. We offer a set of recommendations based on the pharmacology, mechanisms of action and clinical evidence.

Expert opinion: HCQ is the backbone therapy for SLE, and a judicious use must be accomplished, using doses that allow a good control of lupus without compromising the safety of treatments very much prolonged over the time. Stable doses of 200 mg/day seem to accomplish both conditions. GCs should be used more judiciously, with methyl-prednisolone pulses as the main therapy for inducing rapid remission and doses ≤5-2.5 mg/day be never exceeded in long-term maintenance treatments.

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平衡系统性红斑狼疮患者使用羟氯喹和糖皮质激素的风险和益处。

导言：羟氯喹（HCQ）和糖皮质激素（GCs）是治疗系统性红斑狼疮（SLE）的最古老和最常用的药物。尽管使用时间较长，但这两种药物在剂量方面仍存在许多不确定性：我们回顾了 HCQ 和 GCs 的主要作用机制、临床和毒性作用，并分析了 2018 年以来发布的指南中对这两种药物使用的建议。我们根据药理学、作用机制和临床证据提出了一套建议：HCQ是系统性红斑狼疮的骨干疗法，必须合理使用，使用的剂量既要能很好地控制狼疮，又不能影响治疗的安全性，因为治疗时间非常长。每天 200 毫克的稳定剂量似乎可以满足这两个条件。在长期维持治疗中，甲基泼尼松龙脉冲应作为诱导快速缓解的主要疗法，且剂量不得超过每天 5-2.5 毫克。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Clinical Immunology IMMUNOLOGY-

CiteScore

7.60

自引率

2.30%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Expert Review of Clinical Immunology (ISSN 1744-666X) provides expert analysis and commentary regarding the performance of new therapeutic and diagnostic modalities in clinical immunology. Members of the International Editorial Advisory Panel of Expert Review of Clinical Immunology are the forefront of their area of expertise. This panel works with our dedicated editorial team to identify the most important and topical review themes and the corresponding expert(s) most appropriate to provide commentary and analysis. All articles are subject to rigorous peer-review, and the finished reviews provide an essential contribution to decision-making in clinical immunology. Articles focus on the following key areas: • Therapeutic overviews of specific immunologic disorders highlighting optimal therapy and prospects for new medicines • Performance and benefits of newly approved therapeutic agents • New diagnostic approaches • Screening and patient stratification • Pharmacoeconomic studies • New therapeutic indications for existing therapies • Adverse effects, occurrence and reduction • Prospects for medicines in late-stage trials approaching regulatory approval • Novel treatment strategies • Epidemiological studies • Commentary and comparison of treatment guidelines Topics include infection and immunity, inflammation, host defense mechanisms, congenital and acquired immunodeficiencies, anaphylaxis and allergy, systemic immune diseases, organ-specific inflammatory diseases, transplantation immunology, endocrinology and diabetes, cancer immunology, neuroimmunology and hematological diseases.

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