系统性红斑狼疮的管理:为 2023 年 EULAR 建议更新提供信息的系统性文献综述。

IF 20.3 1区 医学 Q1 RHEUMATOLOGY
Myrto Kostopoulou, Chetan B Mukhtyar, George Bertsias, Dimitrios T Boumpas, Antonis Fanouriakis
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引用次数: 0

摘要

目的:分析系统性红斑狼疮(SLE)管理的新证据(2018-2022 年),为欧洲抗风湿联盟(EULAR)2023 年的建议更新提供信息:根据 EULAR 标准化操作程序,在 Medline 和 Cochrane 图书馆数据库中对 2018 年 1 月 1 日至 2022 年 12 月 31 日期间的出版物进行了系统文献综述。研究问题集中在五个不同的领域,即系统性红斑狼疮治疗的益处/害处、达到缓解/低疾病活动度的益处、治疗减量/停药的风险/益处、系统性红斑狼疮合并抗磷脂综合征的管理以及水痘带状疱疹病毒和SARS-CoV2感染免疫接种的安全性。我们采用了 "人群、干预、比较和结果 "框架来为每个研究课题制定检索字符串:我们发现了 439 篇相关文章,其中大部分是中低质量的观察性研究。高质量的随机对照试验(RCT)证明了1型干扰素受体抑制剂anifrolumab对非肾性系统性红斑狼疮的疗效,以及贝利木单抗和新型钙神经蛋白抑制剂voclosporin对狼疮肾炎(LN)的疗效。在治疗狼疮肾炎以外的特定器官表现方面,缺乏高质量的数据。多项观察性研究证实,达到临床缓解或低疾病活动度可降低多种不良后果的风险。两项随机试验发现,在系统性红斑狼疮和LN患者中,停用糖皮质激素(GC)或免疫抑制剂的患者复发率较高,但观察性队列研究表明,部分患者可能可以停用治疗:结论:在肾外系统性红斑狼疮的治疗中,阿尼单抗和贝利木单抗能比标准疗法更好地控制疾病,而在LN的高质量研究中,贝利木单抗和voclosporin联合疗法能获得更高的应答率。缓解和低疾病活动度与良好的长期疗效相关。对于达到这些目标的患者,可逐渐减少GC和免疫抑制疗法。立即引用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of systemic lupus erythematosus: a systematic literature review informing the 2023 update of the EULAR recommendations.

Objectives: To analyse the new evidence (2018-2022) for the management of systemic lupus erythematosus (SLE) to inform the 2023 update of the European League Against Rheumatism (EULAR) recommendations.

Methods: Systematic literature reviews were performed in the Medline and the Cochrane Library databases capturing publications from 1 January 2018 through 31 December 2022, according to the EULAR standardised operating procedures. The research questions focused on five different domains, namely the benefit/harm of SLE treatments, the benefits from the attainment of remission/low disease activity, the risk/benefit from treatment tapering/withdrawal, the management of SLE with antiphospholipid syndrome and the safety of immunisations against varicella zoster virus and SARS-CoV2 infection. A Population, Intervention, Comparison and Outcome framework was used to develop search strings for each research topic.

Results: We identified 439 relevant articles, the majority being observational studies of low or moderate quality. High-quality randomised controlled trials (RCTs) documented the efficacy of the type 1 interferon receptor inhibitor, anifrolumab, in non-renal SLE, and belimumab and voclosporin, a novel calcineurin inhibitor, in lupus nephritis (LN), when compared with standard of care. For the treatment of specific organ manifestations outside LN, a lack of high-quality data was documented. Multiple observational studies confirmed the beneficial effects of attaining clinical remission or low disease activity, reducing the risk for multiple adverse outcomes. Two randomised trials with some concerns regarding risk of bias found higher rates of relapse in patients who discontinued glucocorticoids (GC) or immunosuppressants in SLE and LN, respectively, yet observational cohort studies suggest that treatment withdrawal might be feasible in a subset of patients.

Conclusion: Anifrolumab and belimumab achieve better disease control than standard of care in extrarenal SLE, while combination therapies with belimumab and voclosporin attained higher response rates in high-quality RCTs in LN. Remission and low disease activity are associated with favourable long-term outcomes. In patients achieving these targets, GC and immunosuppressive therapy may gradually be tapered. Cite Now.

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来源期刊
Annals of the Rheumatic Diseases
Annals of the Rheumatic Diseases 医学-风湿病学
CiteScore
35.00
自引率
9.90%
发文量
3728
审稿时长
1.4 months
期刊介绍: Annals of the Rheumatic Diseases (ARD) is an international peer-reviewed journal covering all aspects of rheumatology, which includes the full spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research, including the most important recommendations for the management of various conditions.
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