Info
🌱 來自: Huppert’s Notes
Systemic Lupus Erythematosus (SLE)🚧 施工中
Systemic Lupus Erythematosus (SLE)
• A randomized study of the effect of withdrawing hydroxychloroquine sulfate in systemic lupus erythematosus. New Engl J Med 1991;324:150–154.
- Small, double-blind randomized controlled trial that randomized patients to either continue hydroxychloroquine therapy or to replace hydroxychloroquine with placebo for 24 weeks. The relative risk of clinical flare was 2.5x higher in the placebo arm than the hydroxychloroquine. This demonstrated that patients with quiescent SLE on hydroxychloroquine were less likely to have a clinical flare-up if they were maintained on the drug.
• Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol 2009;20:1103–1112.
- Randomized, single-blind study comparing IV cyclophosphamide 0.5–1 g/m2 monthly) to PO mycophenolate (3 g/d) for treatment of class III and IV lupus nephritis. Mycophenolate was non-inferior to cyclophosphamide for achieving the primary outcome of decrease in UPCR and stabilization in serum creatinine at 24 weeks. Prior studies established less infections, alopecia, and amenorrhea with mycophenolate compared to cyclophosphamide (New Engl J Med 2005;353:2219 and J Rheum 2011;38:69).
• Development of autoantibodies before the clinical onset of systemic lupus erythematosus. New Engl J Med 2003;349:1526–1533.
- Retrospective study of 130 armed forces personnel who provided serum on enlistment and biennially thereafter, showing that autoantibodies including ANA and dsDNA develop years before SLE diagnosis (mean of 3 yr vs. 2.2 yr, respectively). This study suggests that a break in humoral immune tolerance is not sufficient to cause pathology and raises intriguing questions about whether there are additional immunologic and environmental modifying factors (e.g., autoantibody post-translational modifications, infections, microbiome perturbations) needed to cause disease.