糖皮质激素停用对系统性红斑狼疮复发风险的影响:一项系统综述和荟萃分析

IF 4.6 2区 综合性期刊 Q1 MULTIDISCIPLINARY SCIENCES
Sicheng Huang , Yimeng Jia , Yuelun Zhang , Hongda Chen , Chuiwen Deng , Yunyun Fei
{"title":"糖皮质激素停用对系统性红斑狼疮复发风险的影响:一项系统综述和荟萃分析","authors":"Sicheng Huang ,&nbsp;Yimeng Jia ,&nbsp;Yuelun Zhang ,&nbsp;Hongda Chen ,&nbsp;Chuiwen Deng ,&nbsp;Yunyun Fei","doi":"10.1016/j.isci.2025.112875","DOIUrl":null,"url":null,"abstract":"<div><div>Whether discontinuing glucocorticoids (GCs) increases relapse risk in systemic lupus erythematosus (SLE) remains a critical consideration. A systematic review and meta-analysis of 10 randomized clinical trials (RCTs) and observational cohort studies was conducted to evaluate relapse outcomes after GC withdrawal versus maintenance. RCTs showed that GC withdrawal led to a higher overall relapse rate (risk difference [RD] 0.13; 95% CI 0.03–0.23; <em>p</em> = 0.008) and an increased rate of severe relapses (RD 0.02; 95% CI 0.00–0.05; <em>p</em> = 0.04), whereas observational cohorts found similar relapse rates between withdrawal and maintenance and demonstrated non-inferiority within a 15% margin. These findings indicate that GC withdrawal should be approached with caution in patients with SLE, and more research is needed to identify which patients can safely discontinue GC. This review should help guide the choice of maintenance therapy and highlights the need for personalized tapering strategies to optimize long-term outcomes in SLE management.</div></div>","PeriodicalId":342,"journal":{"name":"iScience","volume":"28 7","pages":"Article 112875"},"PeriodicalIF":4.6000,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of glucocorticoid withdrawal on relapse risk in systemic lupus erythematosus: A systematic review and meta-analysis\",\"authors\":\"Sicheng Huang ,&nbsp;Yimeng Jia ,&nbsp;Yuelun Zhang ,&nbsp;Hongda Chen ,&nbsp;Chuiwen Deng ,&nbsp;Yunyun Fei\",\"doi\":\"10.1016/j.isci.2025.112875\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div>Whether discontinuing glucocorticoids (GCs) increases relapse risk in systemic lupus erythematosus (SLE) remains a critical consideration. A systematic review and meta-analysis of 10 randomized clinical trials (RCTs) and observational cohort studies was conducted to evaluate relapse outcomes after GC withdrawal versus maintenance. RCTs showed that GC withdrawal led to a higher overall relapse rate (risk difference [RD] 0.13; 95% CI 0.03–0.23; <em>p</em> = 0.008) and an increased rate of severe relapses (RD 0.02; 95% CI 0.00–0.05; <em>p</em> = 0.04), whereas observational cohorts found similar relapse rates between withdrawal and maintenance and demonstrated non-inferiority within a 15% margin. These findings indicate that GC withdrawal should be approached with caution in patients with SLE, and more research is needed to identify which patients can safely discontinue GC. This review should help guide the choice of maintenance therapy and highlights the need for personalized tapering strategies to optimize long-term outcomes in SLE management.</div></div>\",\"PeriodicalId\":342,\"journal\":{\"name\":\"iScience\",\"volume\":\"28 7\",\"pages\":\"Article 112875\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-06-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"iScience\",\"FirstCategoryId\":\"103\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589004225011368\",\"RegionNum\":2,\"RegionCategory\":\"综合性期刊\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MULTIDISCIPLINARY SCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"iScience","FirstCategoryId":"103","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589004225011368","RegionNum":2,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MULTIDISCIPLINARY SCIENCES","Score":null,"Total":0}
引用次数: 0

摘要

停用糖皮质激素(GCs)是否会增加系统性红斑狼疮(SLE)的复发风险仍然是一个关键的考虑因素。对10项随机临床试验(rct)和观察性队列研究进行了系统回顾和荟萃分析,以评估GC停药与维持后的复发结果。随机对照试验显示,GC停药导致总体复发率升高(风险差[RD] 0.13;95% ci 0.03-0.23;p = 0.008),严重复发率增加(RD为0.02;95% ci 0.00-0.05;P = 0.04),而观察性队列发现停药和维持之间的复发率相似,并且在15%的范围内证明非劣效性。这些研究结果表明,SLE患者应谨慎停用GC,需要更多的研究来确定哪些患者可以安全地停用GC。这篇综述应该有助于指导维持治疗的选择,并强调个性化的逐渐减少策略的必要性,以优化SLE管理的长期结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Effects of glucocorticoid withdrawal on relapse risk in systemic lupus erythematosus: A systematic review and meta-analysis

Effects of glucocorticoid withdrawal on relapse risk in systemic lupus erythematosus: A systematic review and meta-analysis
Whether discontinuing glucocorticoids (GCs) increases relapse risk in systemic lupus erythematosus (SLE) remains a critical consideration. A systematic review and meta-analysis of 10 randomized clinical trials (RCTs) and observational cohort studies was conducted to evaluate relapse outcomes after GC withdrawal versus maintenance. RCTs showed that GC withdrawal led to a higher overall relapse rate (risk difference [RD] 0.13; 95% CI 0.03–0.23; p = 0.008) and an increased rate of severe relapses (RD 0.02; 95% CI 0.00–0.05; p = 0.04), whereas observational cohorts found similar relapse rates between withdrawal and maintenance and demonstrated non-inferiority within a 15% margin. These findings indicate that GC withdrawal should be approached with caution in patients with SLE, and more research is needed to identify which patients can safely discontinue GC. This review should help guide the choice of maintenance therapy and highlights the need for personalized tapering strategies to optimize long-term outcomes in SLE management.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
iScience
iScience Multidisciplinary-Multidisciplinary
CiteScore
7.20
自引率
1.70%
发文量
1972
审稿时长
6 weeks
期刊介绍: Science has many big remaining questions. To address them, we will need to work collaboratively and across disciplines. The goal of iScience is to help fuel that type of interdisciplinary thinking. iScience is a new open-access journal from Cell Press that provides a platform for original research in the life, physical, and earth sciences. The primary criterion for publication in iScience is a significant contribution to a relevant field combined with robust results and underlying methodology. The advances appearing in iScience include both fundamental and applied investigations across this interdisciplinary range of topic areas. To support transparency in scientific investigation, we are happy to consider replication studies and papers that describe negative results. We know you want your work to be published quickly and to be widely visible within your community and beyond. With the strong international reputation of Cell Press behind it, publication in iScience will help your work garner the attention and recognition it merits. Like all Cell Press journals, iScience prioritizes rapid publication. Our editorial team pays special attention to high-quality author service and to efficient, clear-cut decisions based on the information available within the manuscript. iScience taps into the expertise across Cell Press journals and selected partners to inform our editorial decisions and help publish your science in a timely and seamless way.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信