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Author: Chinese Snacks
Lupus, especially systemic lupus erythematosus, its symptoms seriously affect the lives of patients, and if the disease is aggravated, it will damage the organs and cause death.
It is an important branch of autoimmune system diseases in recent decades, and it is also the field of constant fever for the development of new drugs
.
Although many drugs have entered the treatment process, there is no radical drug.
Disease characteristics
Disease characteristicsSystemic lupus erythematosus (Systemic Lupuseryth Ematosus, SLE) is a systemic autoimmune disease; the main clinical features are multi-system and multi-organ involvement, repeated recurrence and remission, and the presence of a large number of autoantibodies in the body.
Causes irreversible damage to the involved organs and ultimately leads to the death of the patient
.
The etiology of SLE is complex and is related to multiple factors such as heredity, sex hormones, environment, etc.
In particular, with the current changes in people's living and living habits, the incidence of women has increased significantly and has to be taken seriously
.
Incidence & Survival Rate
Incidence & Survival RateAt present, the global prevalence of SLE is approximately 240/100,000, and the prevalence of SLE in mainland China is about 30-70/100,000, and the male to female prevalence ratio is 1:10-12
.
In terms of survival rate, the 5-year survival rate of SLE patients increased from 50% to 60% in the 1950s to more than 90% in the 1990s, and gradually stabilized from 2008 to 2016 (the 5-year survival rate in high-income countries 95%, the 5-year survival rate of low- and middle-income countries is 92%)
.
PS: At present, it is no longer possible to just look at the 5-year survival rate.
Figure 2 The incidence of systemic lupus erythematosus in different regions (1975~2000)
Treatment strategy
Treatment strategyPrevention, reduction of recurrence and control of organ damage caused by disease, reduction of patient mortality, improvement of survival rate and quality of life are the long-term goals of SLE treatment
.
China’s guidelines point out (2020 edition): Among SLE patients with a course of less than 4 years, about 25% of patients can achieve clinical remission after treatment, and 45% of patients have organ damage
.
Recurrence is a common clinical feature of SLE patients, a sign of a marked increase in disease activity, and the main cause of organ damage and poor prognosis.
The total risk of recurrence in SLE patients within 4 years is 60%, and its high-risk factors include low age of onset, Continuous clinical disease activity and serological activity
.
After reaching disease remission or minimum disease activity, treatment strategies usually need to be adjusted to prevent and reduce recurrence.
Compared with SLE patients with poorly controlled disease activity, disease remission is achieved (HR=0.
60, 95%CI 0.
43~0.
85) And low disease activity (HR=0.
66, 95%CI0.
48~0.
93) can reduce the new injury of SLE patients, which is closely related to the prognosis
.
Figure 3 Comparison of EULAR Guide & DORIS
medical treatement
medical treatementThe global treatment of SLE focuses on drug therapy; drug therapy is mainly divided into: glucocorticoids, antimalarial drugs, immunosuppressive agents, and biological agents
.
➢ Hormones
Hormones are the basic drugs for SLE induction and remission treatment, and are unanimously recommended by domestic and foreign guidelines to control the condition of SLE
.
For SLE patients, individualized treatment should be carried out according to the degree of disease activity, the length of medication time, and the adverse effects of hormones
Figure 4 Individualized treatment strategies for SLE glucocorticoids
➢ Antimalarial drugs
Long-term use of hydroxychloroquine can reduce disease activity, reduce the risk of organ damage and thrombosis, improve blood lipids, and improve survival
.
People who take hydroxychloroquine for a long time can observe retinopathy caused by hydroxychloroquine after 5 years, and some high-risk groups are more likely to induce retinopathy
➢Immunosuppressive agents
The use of immunosuppressive agents can reduce the cumulative use of hormones and prevent disease recurrence
.
For patients with refractory or relapsed SLE, the use of immunosuppressive agents can reduce the use of hormones, control disease activity, and improve clinical remission rates
➢ Biologics
For patients with refractory or relapsed SLE, the use of biological agents can significantly increase the patient's complete and partial remission rate, reduce disease activity, disease recurrence rate, and reduce hormone dosage
.
Although a variety of biological agents have been tried for the treatment of SLE and have achieved certain clinical effects, currently only belyumumab has been approved by the FDA and NMPA for the treatment of SLE, and Tetazep has been approved for marketing by the NMPA
Figure 5 Domestic guidelines for SLE treatment medication order
Progress in domestic clinical drug development
Progress in domestic clinical drug developmentJudging from the development of domestic clinical trials, dozens of varieties of indication-related "systemic lupus erythematosus" have been clinically studied: Anifrolumab injection, beliyuumab injection, tetaxel, and rituximab.
references:
1.
2.
3.
4.
Chinese Journal of Internal Medicine, March 2020, Vol.
59, No.
3 Chin J Intern Med, March 2020, Vol.
59, No.
3
5.
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