The utility of layering systemic therapies in connective tissue diseases

Kezia Surjanto, Lixin Ji, Erin Boh, Carole Bitar
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引用次数: 0

Abstract

Background

Cutaneous manifestations in connective tissue diseases (CTDs) are often chronic and difficult to control.

Objectives

This study aims to review the use of combination systemic medications in CTDs and assess disease response.

Methods

An IRB-approved, retrospective chart review was conducted at a single large academic institution in New Orleans, Louisiana. Inclusion criteria were adult patients with CTDs on two or more systemic therapies.

Results

Out of 101 patients, 37.62% were taking combination systemic agents. Of these patients, 44% were diagnosed with lupus, 18% with dermatomyositis (DM), 8% with systemic scleroderma (SSc), 10% with morphea/limited scleroderma (M), 12% with mixed connective tissue disease (MCTD), and 8% with rheumatoid arthritis (RA). The most common regimen for lupus, MCTD, and SSc patients was hydroxychloroquine (HCQ) + prednisone (PRED) + mycophenolate mofetil (MMF). DM patients were most commonly taking combinations of the above regimen with intravenous immunoglobulin (IVIG). Morphea and RA patients were on multiple combinations of steroid and nonsteroidal agents including MMF, IVIG, azathioprine, methotrexate, HCQ, sulfasalazine, upadacitinib, apremilast, and tofacitinib.

Conclusions

This study aims to assess the efficacy of combination systemic medications and disease response in CTDs. Lupus was the most common CTD in our study, with patients taking 2–4 combination medications. HCQ, MMF, and PRED were the most common medications used within a combination regimen with minimal adverse effects. Though our study has several limitations including its retrospective nature and small sample size, it shows that CTDs can be resistant to monotherapy and that combination therapy might be required. More research in layering systemic agents is needed since this topic is currently limited to minimal case series and clinical trials.

结缔组织疾病分层系统疗法的效用
结缔组织病(CTD)的皮肤表现往往是慢性的,难以控制。本研究旨在回顾结缔组织病联合全身用药的使用情况,并评估疾病反应。路易斯安那州新奥尔良市的一家大型学术机构进行了一项经 IRB 批准的回顾性病历审查。纳入标准是正在接受两种或两种以上系统疗法的 CTD 成年患者。在 101 名患者中,37.62% 正在服用联合系统疗法药物。在这些患者中,44%被诊断为狼疮,18%被诊断为皮肌炎(DM),8%被诊断为系统性硬皮病(SSc),10%被诊断为斑秃/局限性硬皮病(M),12%被诊断为混合性结缔组织病(MCTD),8%被诊断为类风湿性关节炎(RA)。狼疮、MCTD 和 SSc 患者最常用的治疗方案是羟氯喹(HCQ)+泼尼松(PRED)+霉酚酸酯(MMF)。糖尿病患者最常服用的是上述疗法与静脉注射免疫球蛋白(IVIG)的组合。莫泊桑和红斑狼疮患者使用多种类固醇和非类固醇药物组合,包括MMF、IVIG、硫唑嘌呤、甲氨蝶呤、HCQ、磺胺沙拉嗪、达帕替尼、阿普仑司特和托法替尼。在我们的研究中,红斑狼疮是最常见的CTD,患者服用2-4种联合药物。HCQ、MMF和PRED是联合用药方案中最常用的药物,且不良反应最小。虽然我们的研究存在一些局限性,包括其回顾性和样本量较小,但它表明 CTD 可能对单药治疗产生耐药性,可能需要联合治疗。由于这一课题目前仅限于极少的病例系列和临床试验,因此还需要对分层系统用药进行更多的研究。
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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