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Zavaleta-Monestel E, Arrieta-Vega D, Rojas-Chinchilla C, Campos-Hernández J, García-Montero J, Quesada-Villaseñor R, Anchía-Alfaro A, Arguedas-Chacón S. Advances in Systemic Lupus Erythematosus Treatment With Monoclonal Antibodies: A Mini-Review. Cureus 2024; 16:e64090. [PMID: 39114252 PMCID: PMC11305445 DOI: 10.7759/cureus.64090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 08/10/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs and systems. It is characterized by the production of abnormal antibodies that attack healthy cells and tissues. The disease presents a wide range of symptoms and severity, from mild to severe. Diagnosis can be complex, but the classification criteria of the American College of Rheumatology (ACR) help to facilitate it. Incidence and prevalence vary considerably worldwide, mainly affecting adult women between the third and fourth decades of life, although it can also occur in childhood. The prognosis of SLE has improved over time, but there is still a risk of irreversible organ damage. Treatment is individualized for each patient and is based on immunosuppression and the use of corticosteroids. Biological therapies, such as monoclonal antibodies, have emerged as a more specific alternative. Methotrexate, antimalarials, glucocorticoids, immunosuppressants, and monoclonal antibodies are some of the medications used to treat SLE. New therapeutic strategies are currently being developed, such as targeted therapies, immunomodulators, and biological agents. Treatment adherence, monitoring, and regular follow-up are important aspects of SLE management. This article aims to describe the characteristics of the new monoclonal antibody therapies that exist for the management of SLE.
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Fasano S, Messiniti V, Iudici M, Coscia MA, Ciccia F. Hydroxychloroquine daily dose, hydroxychloroquine blood levels and the risk of flares in patients with systemic lupus erythematosus. Lupus Sci Med 2023; 10:10/1/e000841. [PMID: 36631164 PMCID: PMC9835942 DOI: 10.1136/lupus-2022-000841] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recent guidelines for SLE recommend using a hydroxychloroquine (HCQ) dose less than 5.0 mg/kg/day to reduce the risk of retinopathy. To determine if this dose reduction would have an impact on the clinical course of SLE, we compared flare incidence in a cohort of patients with SLE treated with two different oral HCQ dosages (≤5 mg/kg/day or >5 mg/kg/day). As a secondary analysis, we compared HCQ blood levels between the two different oral dosages, and evaluated the frequency of non-adherence in patients with SLE treated with HCQ. METHODS We identified a cohort of patients with SLE taking HCQ for at least 6 months and followed for 24 months. At study entry and 6 months later, a blood venous sample was taken to measure HCQ blood levels by liquid chromatography. Incidence of new SLE flares after recruitment was put in relation to daily HCQ dose and mean HCQ blood levels. Cox regression analysis served to identify factors associated with SLE flares. RESULTS 83 patients were enrolled. We observed 11 (16%) flares that developed in mean 14.8 months of follow-up. The difference in terms of flare rate and mean HCQ blood levels between the two oral dosages was not statistically significant. There was a trend (p=0.08) for high HCQ dose being associated with a lower flare rate. At Cox analysis, higher HCQ blood levels and older age at baseline were protective against flare occurrence, while concomitant immunosuppressant therapy showed significant positive association. HCQ blood levels did not correlate with prescribed HCQ dose. CONCLUSION Patients with low oral HCQ dosage tend to have more flares, although the difference was not statistically significant. Higher HCQ blood levels were protective against flare occurrence. The risks and benefits must be balanced in choosing HCQ dose.
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Affiliation(s)
- Serena Fasano
- Rheumatology Unit, Department of Precision Medicine, University of Campania, "Luigi Vanvitelli", Naples, Italy
| | - Valentina Messiniti
- Rheumatology Unit, Department of Precision Medicine, University of Campania, "Luigi Vanvitelli", Naples, Italy
| | - Michele Iudici
- Department of Internal Medicine Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Melania Alessia Coscia
- Rheumatology Unit, Department of Precision Medicine, University of Campania, "Luigi Vanvitelli", Naples, Italy
| | - Francesco Ciccia
- Rheumatology Unit, Department of Precision Medicine, University of Campania, "Luigi Vanvitelli", Naples, Italy
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3
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The combination of hydroxychloroquine and 2-deoxyglucose enhances apoptosis in breast cancer cells by blocking protective autophagy and sustaining endoplasmic reticulum stress. Cell Death Dis 2022; 8:286. [PMID: 35690609 PMCID: PMC9188615 DOI: 10.1038/s41420-022-01074-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 02/06/2023]
Abstract
2-Deoxyglucose (2-DG) can be used in antitumour research by inhibiting glycolysis and promoting the endoplasmic reticulum stress (ERS) pathway, but its clinical application is restricted due to dose-limiting side effects and survival chance for cancer cells by protective autophagy. Therefore, our research explored whether the combination of hydroxychloroquine (HCQ), an FDA-approved autophagy inhibiting drug, and 2-DG is a promising therapeutic strategy. Here, we report that HCQ combined with 2-DG can further inhibit the viability and migration and induce apoptosis of breast tumour cells compared with other individual drugs. The combination of 2-DG and HCQ can significantly reduce transplanted tumour size and tumour cell metastasis of the lung and liver in vivo. At the cellular level, HCQ suppressed autolysosome formation and terminated the autophagy process induced by 2-DG-mediated ERS, resulting in the continuous accumulation of misfolded proteins in the endoplasmic reticulum, which generated sustained ERS through the PERK-eIF2α-ATF-4-CHOP axis and triggered the transformation from a survival process to cell death. Our research reinforced the research interest of metabolic disruptors in triple-negative breast cancer and emphasized the potential of the combination of 2-DG and HCQ as an anticancerous treatment.
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Jia Q, Fu J, Liang P, Wang S, Wang Y, Zhang X, Zhou H, Zhang L, Lv Y, Han S. Investigating interactions between chloroquine/hydroxychloroquine and their single enantiomers and angiotensin-converting enzyme 2 by a cell membrane chromatography method. J Sep Sci 2021; 45:456-467. [PMID: 34729910 PMCID: PMC8661882 DOI: 10.1002/jssc.202100570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/28/2022]
Abstract
Chloroquine and hydroxychloroquine have been studied since the early clinical treatment of SARS‐CoV‐2 outbreak. Considering these two chiral drugs are currently in use as the racemate, high‐expression angiotensin‐converting enzyme 2 cell membrane chromatography was established for investigating the differences of two paired enantiomers binding to angiotensin‐converting enzyme 2 receptor. Molecular docking assay and detection of SARS‐CoV‐2 spike pseudotyped virus entry into angiotensin‐converting enzyme 2‐HEK293T cells were also conducted for further investigation. Results showed that each single enantiomer could bind well to angiotensin‐converting enzyme 2, but there were differences between the paired enantiomers and corresponding racemate in frontal analysis. R‐Chloroquine showed better angiotensin‐converting enzyme 2 receptor binding ability compared to S‐chloroquine/chloroquine (racemate). S‐Hydroxychloroquine showed better angiotensin‐converting enzyme 2 receptor binding ability than R‐hydroxychloroquine/hydroxychloroquine. Moreover, each single enantiomer was proved effective compared with the control group; compared with S‐chloroquine or the racemate, R‐chloroquine showed better inhibitory effects at the same concentration. As for hydroxychloroquine, R‐hydroxychloroquine showed better inhibitory effects than S‐hydroxychloroquine, but it slightly worse than the racemate. In conclusion, R‐chloroquine showed better angiotensin‐converting enzyme 2 receptor binding ability and inhibitory effects compared to S‐chloroquine/chloroquine (racemate). S‐Hydroxychloroquine showed better angiotensin‐converting enzyme 2 receptor binding ability than R‐hydroxychloroquine/hydroxychloroquine (racemate), while the effect of preventing SARS‐CoV‐2 pseudovirus from entering cells was weaker than R‐hydroxychloroquine/hydroxychloroquine (racemate).
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Affiliation(s)
- Qianqian Jia
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Institute of Pharmaceutical Science and Technology, Western China Science &Technology Innovation Harbour, Xi'an, 710000, P. R. China
| | - Jia Fu
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Institute of Pharmaceutical Science and Technology, Western China Science &Technology Innovation Harbour, Xi'an, 710000, P. R. China
| | - Peida Liang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Institute of Pharmaceutical Science and Technology, Western China Science &Technology Innovation Harbour, Xi'an, 710000, P. R. China
| | - Saisai Wang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Institute of Pharmaceutical Science and Technology, Western China Science &Technology Innovation Harbour, Xi'an, 710000, P. R. China
| | - Yamin Wang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Institute of Pharmaceutical Science and Technology, Western China Science &Technology Innovation Harbour, Xi'an, 710000, P. R. China
| | - Xin Zhang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Institute of Pharmaceutical Science and Technology, Western China Science &Technology Innovation Harbour, Xi'an, 710000, P. R. China
| | - Huaxin Zhou
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Institute of Pharmaceutical Science and Technology, Western China Science &Technology Innovation Harbour, Xi'an, 710000, P. R. China
| | - Liyang Zhang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Institute of Pharmaceutical Science and Technology, Western China Science &Technology Innovation Harbour, Xi'an, 710000, P. R. China
| | - Yanni Lv
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Institute of Pharmaceutical Science and Technology, Western China Science &Technology Innovation Harbour, Xi'an, 710000, P. R. China
| | - Shengli Han
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, P. R. China.,Institute of Pharmaceutical Science and Technology, Western China Science &Technology Innovation Harbour, Xi'an, 710000, P. R. China
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5
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Lenfant T, Salah S, Leroux G, Bousquet E, Le Guern V, Chasset F, Francès C, Morel N, Chezel J, Papo T, Cacoub P, Mouthon L, Guettrot-Imbert G, Cohen P, Régent A, Mauget-Faÿsse M, Piette JC, Jallouli M, Costedoat-Chalumeau N. Risk factors for hydroxychloroquine retinopathy in systemic lupus erythematosus: a case-control study with hydroxychloroquine blood-level analysis. Rheumatology (Oxford) 2021; 59:3807-3816. [PMID: 32442312 PMCID: PMC8186841 DOI: 10.1093/rheumatology/keaa157] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/05/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE HCQ is an essential medication in SLE, proven to lengthen survival and reduce flares. Its use, however, is limited by its rare but severe ophthalmological complications. Here, we aimed to analyse factors associated with HCQ retinopathy including HCQ blood levels. METHODS This case-control study compared SLE patients with and without HCQ retinopathy, defined by abnormal results for at least two of the following ophthalmological tests: automated visual fields, spectral-domain optical coherence tomography (SD-OCT), multifocal electroretinogram (mfERG) and fundus autofluorescence. We compared clinical and laboratory findings to assess risk factors for HCQ retinopathy. RESULTS The study included 23 patients with confirmed retinopathy (cases) and 547 controls. In the univariate analysis, age (P < 0.001), height (P = 0.045), creatinine clearance (P < 0.001), haemoglobin concentration (P = 0.01), duration of HCQ intake, (P < 0.001), higher cumulative HCQ dose (P < 0.001) and geographical origin (West Indies and sub-Saharan Africa) (P = 0.007) were associated with the risk of retinopathy, while HCQ blood levels were not. In the multivariate analysis, only cumulative dose (P = 0.016), duration of intake (P = 0.039), creatinine clearance (P = 0.002) and geographical origin (P < 0.0001, odds ratio 8.7) remained significantly associated with retinopathy. CONCLUSION SLE patients on HCQ should be closely monitored for retinopathy, especially those from the West Indies or sub-Saharan Africa, or with renal insufficiency, longer HCQ intake or a high cumulative dose. Although reducing the daily dose of HCQ in patients with persistently high HCQ blood levels seems logical, these concentrations were not associated with retinopathy in this study with controls adherent to treatment.
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Affiliation(s)
- Tiphaine Lenfant
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Sawsen Salah
- Department of Ophthalmology, Ophtalmopôle, Cochin Hospital, APHP
| | - Gaëlle Leroux
- Department of Internal Medicine and Clinical Immunology, Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Pitié-Salpêtrière University Hospital, APHP
| | - Elodie Bousquet
- Department of Ophthalmology, Ophtalmopôle, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris
| | - Véronique Le Guern
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - François Chasset
- Department of Dermatology and Allergology, Tenon Hospital, APHP.,Faculty of Medicine, Sorbonne University
| | - Camille Francès
- Department of Dermatology and Allergology, Tenon Hospital, APHP
| | - Nathalie Morel
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Julie Chezel
- Department of Internal Medicine, Bichat-Claude Bernard Hospital, APHP
| | - Thomas Papo
- Faculty of Medicine, Université de Paris.,Department of Internal Medicine, Bichat-Claude Bernard Hospital, APHP
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Pitié-Salpêtrière University Hospital, APHP.,Faculty of Medicine, Sorbonne University.,INSERM, UMR_S 959.,Paris CNRS, FRE3632
| | - Luc Mouthon
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris.,INSERM U1016, Équipe Neutrophiles et Vascularites, Institut Cochin
| | - Gaëlle Guettrot-Imbert
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Pascal Cohen
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Alexis Régent
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris
| | - Martine Mauget-Faÿsse
- Clinical Investigative Platform, Rothschild Ophthalmologic Foundation Hospital, Paris, France
| | - Jean-Charles Piette
- Department of Internal Medicine and Clinical Immunology, Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Pitié-Salpêtrière University Hospital, APHP
| | - Moez Jallouli
- Department of Internal Medicine, Hédi Chaker Sfax Hospital, Sfax, Tunisia
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris.,Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), INSERM U1153, Paris, France
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6
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Banerjee S. Hydroxychloroquine: balancing the needs of LMICs during the COVID-19 pandemic. THE LANCET RHEUMATOLOGY 2020; 2:e385-e386. [PMID: 32835239 PMCID: PMC7255204 DOI: 10.1016/s2665-9913(20)30162-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Costedoat-Chalumeau N, Houssiau FA. Ustekinumab: a promising new drug for SLE? Lancet 2018; 392:1284-1286. [PMID: 30249508 DOI: 10.1016/s0140-6736(18)32330-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, 75014 Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France.
| | - Frédéric A Houssiau
- Service de Rhumatologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Université Catholique de Louvain, Brussels, Belgium
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8
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Costedoat‐Chalumeau N, Houssiau F, Izmirly P, Guern VL, Navarra S, Jolly M, Ruiz‐Irastorza G, Baron G, Hachulla E, Agmon‐Levin N, Shoenfeld Y, Dall'Ara F, Buyon J, Deligny C, Cervera R, Lazaro E, Bezanahary H, Leroux G, Morel N, Viallard J, Pineau C, Galicier L, Vollenhoven RV, Tincani A, Nguyen H, Gondran G, Zahr N, Pouchot J, Piette J, Petri M, Isenberg D. A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring
SLE
: Assessment by Drug Levels and Self‐Administered Questionnaires. Clin Pharmacol Ther 2018; 106:374-382. [DOI: 10.1002/cpt.1194] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Nathalie Costedoat‐Chalumeau
- Internal Medicine DepartmentCentre de Référence Maladies Auto‐Immunes et Systémiques RaresAP‐HPCochin Hospital Paris France
- Université Paris Descartes‐Sorbonne Paris Cité Paris France
- Center for Epidemiology and StatisticsINSERM U 1153Sorbonne Paris Cité (CRESS) Paris France
| | - Frédéric Houssiau
- Service de RhumatologieCliniques Universitaires Saint‐LucPôle de Pathologies Rhumatismales Inflammatoires et SystémiquesUniversité catholique de Louvain Brussels Belgium
| | - Peter Izmirly
- Division of RheumatologyDepartment of MedicineNew York University School of Medicine New York New York USA
| | - Véronique Le Guern
- Internal Medicine DepartmentCentre de Référence Maladies Auto‐Immunes et Systémiques RaresAP‐HPCochin Hospital Paris France
- Université Paris Descartes‐Sorbonne Paris Cité Paris France
- Center for Epidemiology and StatisticsINSERM U 1153Sorbonne Paris Cité (CRESS) Paris France
| | | | - Meenakshi Jolly
- Rush University Medical CenterRush Lupus Clinic Chicago Illinois USA
| | - Guillermo Ruiz‐Irastorza
- Autoimmune Diseases Research UnitDepartment of Internal MedicineBioCruces Health Research InstituteHospital Universitario CrucesUniversity of the Basque Country Barakaldo Spain
| | - Gabriel Baron
- Centre d'Epidémiologie CliniqueAP‐HPHôpitalHôtel‐DieuUniversité Paris Descartes‐Sorbonne Paris Cité Paris France
| | - Eric Hachulla
- Claude Huriez HospitalInternal Medicine DepartmentCentre de Référence Maladies Auto‐immunes et Systémiques raresUniversité de Lille Lille France
| | - Nancy Agmon‐Levin
- Sheba Medical CenterZabludowicz Center for Autoimmune Diseases Tel‐Hashomer Israel
| | - Yehuda Shoenfeld
- Sheba Medical CenterZabludowicz Center for Autoimmune Diseases Tel‐Hashomer Israel
| | - Francesca Dall'Ara
- Rheumatology and Clinical Immunology UnitSpedali Civili and Department of Clinical and Experimental ScienceUniversity of Brescia Brescia Italy
| | - Jill Buyon
- Division of RheumatologyDepartment of MedicineNew York University School of Medicine New York New York USA
| | - Christophe Deligny
- Internal Medicine DepartmentPierre‐Zobda‐Quitman Hospital Martinique France
| | - Ricard Cervera
- Department of Autoimmune DiseasesHospital Clínic de Barcelona Barcelona Spain
| | | | - Holy Bezanahary
- Internal Medicine DepartmentDupuytren Hospital Limoges France
| | - Gaëlle Leroux
- Internal Medicine DepartmentAP‐HPPitié‐Salpêtrière HospitalUniversité Pierre et Marie Curie Paris France
| | - Nathalie Morel
- Internal Medicine DepartmentCentre de Référence Maladies Auto‐Immunes et Systémiques RaresAP‐HPCochin Hospital Paris France
- Université Paris Descartes‐Sorbonne Paris Cité Paris France
- Center for Epidemiology and StatisticsINSERM U 1153Sorbonne Paris Cité (CRESS) Paris France
| | | | | | - Lionel Galicier
- Clinical Immunology DepartmentAP‐HPSt Louis Hospital Paris France
| | - Ronald Van Vollenhoven
- Department of MedicineUnit for Clinical Research TherapyInflammatory DiseasesKarolinska University Hospital Stockholm Sweden
| | - Angela Tincani
- Rheumatology and Clinical Immunology UnitSpedali Civili and Department of Clinical and Experimental ScienceUniversity of Brescia Brescia Italy
| | - Hanh Nguyen
- Centre for RheumatologyUniversity College London London UK
| | | | - Noel Zahr
- Pharmacology DepartmentAP‐HPHopital Pitié‐Salpêtrière Paris France
| | - Jacques Pouchot
- Internal Medicine DepartmentEuropean Georges Pompidou Hospital Paris France
| | - Jean‐Charles Piette
- Internal Medicine DepartmentAP‐HPPitié‐Salpêtrière HospitalUniversité Pierre et Marie Curie Paris France
| | - Michelle Petri
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - David Isenberg
- Centre for RheumatologyUniversity College London London UK
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9
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Costedoat-Chalumeau N, Houssiau F, Izmirly P, Le Guern V, Navarra S, Jolly M, Ruiz-Irastorza G, Baron G, Hachulla E, Agmon-Levin N, Shoenfeld Y, Dall'Ara F, Buyon J, Deligny C, Cervera R, Lazaro E, Bezanahary H, Leroux G, Morel N, Viallard JF, Pineau C, Galicier L, Van Vollenhoven R, Tincani A, Nguyen H, Gondran G, Zahr N, Pouchot J, Piette JC, Petri M, Isenberg D. A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self-Administered Questionnaires. Clin Pharmacol Ther 2017; 103:1074-1082. [PMID: 28925027 DOI: 10.1002/cpt.885] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 01/24/2023]
Abstract
Nonadherence to treatment is a major cause of lupus flares. Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half-life and can be quantified by high-performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ <200 ng/ml or undetectable desethylchloroquine), and self-administered questionnaires (MASRI <80% or MMAS-8 <6). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level. Questionnaires classified 39.9% of patients as nonadherent. Correlations between adherence measured by questionnaires, drug level, and physician assessment were moderate. Both methods probably measured two different patterns of nonadherence: self-administered questionnaires mostly captured relatively infrequently missed tablets, while drug levels identified severe nonadherence (i.e., interruption or erratic tablet intake). The frequency with which physicians miss nonadherence, together with underreporting by patients, suggests that therapeutic drug monitoring is useful in this setting. (Trial registration: ClinicalTrials.gov: NCT01509989.).
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Affiliation(s)
- Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Frédéric Houssiau
- Service de Rhumatologie, Cliniques Universitaires Saint-Luc; Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Université catholique de Louvain, Brussels, Belgium
| | - Peter Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | | | - Meenakshi Jolly
- Rush University Medical Center, Rush Lupus Clinic, Chicago, Illinois, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Gabriel Baron
- AP-HP, Hôpital Hôtel-Dieu, Centre d'Epidémiologie Clinique, Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Eric Hachulla
- Claude Huriez Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques rares, Université de Lille, Lille, France
| | - Nancy Agmon-Levin
- Sheba Medical Center, Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel
| | - Yehuda Shoenfeld
- Sheba Medical Center, Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel
| | - Francesca Dall'Ara
- Rheumatology and Clinical Immunology Unit, Spedali Civili and Dept. of Clinical and Experimental Science-University of Brescia, Italy
| | - Jill Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Christophe Deligny
- Pierre-Zobda-Quitman Hospital, Internal Medicine Department, Martinique, France
| | - Ricard Cervera
- Hospital Clínic de Barcelona, Department of Autoimmune Diseases, Barcelona, Spain
| | - Estibaliz Lazaro
- Haut Lévêque Hospital, Internal Medicine Department, Pessac, France
| | - Holy Bezanahary
- Dupuytren Hospital, Internal Medicine Department, Limoges, France
| | - Gaëlle Leroux
- AP-HP, Pitié-Salpêtrière Hospital, Internal Medicine Department, Université Pierre et Marie Curie, Paris, France
| | - Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | | | | | - Lionel Galicier
- AP-HP, St Louis Hospital, Clinical Immunology Department, Paris, France
| | - Ronald Van Vollenhoven
- Karolinska University Hospital, Department of Medicine, Unit for Clinical Research Therapy, Inflammatory Diseases, Stockholm, Sweden
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Spedali Civili and Dept. of Clinical and Experimental Science-University of Brescia, Italy
| | - Hanh Nguyen
- University College London, Centre for Rheumatology, London, UK
| | | | - Noel Zahr
- AP-HP, Hopital Pitié-Salpêtrière, Pharmacology Department, Paris, France
| | - Jacques Pouchot
- European Georges Pompidou Hospital, Internal Medicine Department, Paris, France
| | - Jean-Charles Piette
- AP-HP, Pitié-Salpêtrière Hospital, Internal Medicine Department, Université Pierre et Marie Curie, Paris, France
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Isenberg
- University College London, Centre for Rheumatology, London, UK
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Wu SF, Chang CB, Hsu JM, Lu MC, Lai NS, Li C, Tung CH. Hydroxychloroquine inhibits CD154 expression in CD4 + T lymphocytes of systemic lupus erythematosus through NFAT, but not STAT5, signaling. Arthritis Res Ther 2017; 19:183. [PMID: 28793932 PMCID: PMC5550984 DOI: 10.1186/s13075-017-1393-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/18/2017] [Indexed: 12/28/2022] Open
Abstract
Background Overexpression of membranous CD154 in T lymphocytes has been found previously in systemic lupus erythematosus (SLE). Because hydroxychloroquine (HCQ) has been used frequently in the treatment of lupus, we sought to identify the effects of HCQ on CD154 and a possibly regulatory mechanism. Methods CD4+ T cells were isolated from the blood of lupus patients. After stimulation with ionomycin or IL-15 and various concentrations of HCQ, expression of membranous CD154 and NFAT and STAT5 signaling were assessed. Results HCQ treatment had significant dose-dependent suppressive effects on membranous CD154 expression in ionomycin-activated T cells from lupus patients. Furthermore, HCQ inhibited intracellular sustained calcium storage release, and attenuated the nuclear translocation of NFATc2 and the expression of NFATc1. However, CD154 expressed through IL-15-mediated STAT5 signaling was not inhibited by HCQ treatment. Conclusions HCQ inhibited NFAT signaling in activated T cells and blocked the expression of membranous CD154, but not STAT5 signaling. These findings provide a mechanistic insight into SLE in HCQ treatment.
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Affiliation(s)
- Shu-Fen Wu
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan
| | - Chia-Bin Chang
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan
| | - Jui-Mei Hsu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.,Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi, Taiwan
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi, Taiwan
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi, Taiwan
| | - Chin Li
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan
| | - Chien-Hsueh Tung
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan. .,Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
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11
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Zou YF, Xu JH, Pan FM, Tao JH, Xu SQ, Xiao H, Liu S, Cai J, Lian L, Chen PL, Wang DG, Liu SX, Liang CM, Ye QL, Tian G, Wu M, Gu YY, Pan HF, Su H, Ye DQ. Glucocorticoid receptor genetic polymorphisms is associated with improvement of health-related quality of life in Chinese population with systemic lupus erythematosus. Clin Rheumatol 2015; 34:1537-44. [DOI: 10.1007/s10067-015-3027-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 06/15/2015] [Accepted: 07/17/2015] [Indexed: 01/09/2023]
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12
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Bekircan-Kurt CE, Tuncer Kurne A, Erdem-Ozdamar S, Kalyoncu U, Karabudak R, Tan E. The course of myasthenia gravis with systemic lupus erythematosus. Eur Neurol 2014; 72:326-9. [PMID: 25323839 DOI: 10.1159/000365568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 06/30/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is one of the autoimmune diseases, which is rarely reported with Myasthenia Gravis (MG). In the literature, the clinical features of MG in these patients were not mentioned in detail. Here, we want to present our five patients with MG and SLE. METHODS Between 2000 and 2010, 132 MG patients were evaluated and have been followed up in our institution. Five patients had MG with SLE and eleven patients had antinuclear antibody (ANA) positivity without SLE symptoms. The clinical, laboratory findings and treatment responses were reviewed. RESULTS All patients had generalized MG and four of five patients experienced at least one myasthenic crisis. The response to corticosteroid was poor; consequently, they needed immunosuppressive treatments, IVIg or plasmapheresis. Although in the literature thymectomy was accused of the precipitation of SLE, in our series SLE symptoms preceded thymectomy. CONCLUSION We would like to point out that MG and SLE being two autoimmune diseases may coexist. This coexistence might cause a more severe myasthenic course compared to MG alone; therefore, these patients need a close and frequent follow-up.
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Affiliation(s)
- Can Ebru Bekircan-Kurt
- Department of Neurology, Hacettepe University School of Medicine, Sıhhiye, Ankara, Turkey
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Schoindre Y, Jallouli M, Tanguy ML, Ghillani P, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z, Souberbielle JC, Costedoat-Chalumeau N. Lower vitamin D levels are associated with higher systemic lupus erythematosus activity, but not predictive of disease flare-up. Lupus Sci Med 2014; 1:e000027. [PMID: 25379192 PMCID: PMC4213833 DOI: 10.1136/lupus-2014-000027] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/03/2014] [Accepted: 05/08/2014] [Indexed: 01/11/2023]
Abstract
Objectives Growing evidence suggests that vitamin D plays a key role in the pathogenesis and progression of autoimmune diseases, including systemic lupus erythematosus (SLE). Recent studies have found an association between lower serum 25-hydroxyvitamin D (25(OH)D) levels and higher SLE activity. We studied the relationship between 25(OH)D levels and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and we assessed for the first time the role of vitamin D in predicting SLE flare-ups. Methods Serum 25(OH)D levels were measured in 170 patients with SLE who were prospectively followed up for 6 months (Plaquenil LUpus Systemic study, ClinicalTrials.gov number NCT00413361). Results The mean SLEDAI score was 2.03±2.43 and 12.3% patients had active disease (SLEDAI ≥6). The mean 25(OH)D level was 20.6±9.8 ng/mL. Deficiency (25(OH)D <10 ng/mL) was observed in 27 (15.9%), insufficiency (10≤25(OH)D<30) in 112 (65.9%) and optimal vitamin D status (25(OH)D≥30) in 31 (18.2%) patients. In multivariate analysis, female gender (p=0.018), absence of defined antiphospholipid syndrome (p=0.002) and higher creatinine clearance (p=0.004) were predictive of lower 25(OH)D levels. In multivariate analysis, lower 25(OH)D levels were associated with high SLE activity (p=0.02). Relapse-free survival rate was not statistically different according to the vitamin D status during the 6-month follow-up (p=0.22). Conclusions We found a low vitamin D status in the majority of patients with SLE, and a modest association between lower 25(OH)D levels and high disease activity. There was no association between baseline 25(OH)D levels and relapse-free survival rate.
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Affiliation(s)
- Yoland Schoindre
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Médecine Interne 1, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Moez Jallouli
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Marie-Laure Tanguy
- AP-HP, Hôpital Pitié-Salpêtrière, Unité de recherche clinique, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Pascale Ghillani
- AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire d'Immunochimie, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Lionel Galicier
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Saint-Louis, Service d'Immunologie Clinique, 1 avenue Claude Vellefaux , Paris , France
| | - Olivier Aumaître
- Université de Clermont-Ferrand , Clermont-Ferrand , France ; CHU Clermont-Ferrand, Hôpital Gabriel Montpied, service de Médecine Interne , Clermont-Ferrand, Cedex , France
| | - Camille Francès
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Tenon, Service de Dermatologie Allergologie , Paris , France
| | - Véronique Le Guern
- Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Cochin, Service de Médecine Interne , Paris , France
| | - Frédéric Lioté
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Lariboisière, Service de Rhumatologie , Paris , France
| | - Amar Smail
- CHU Amiens, Hôpital Nord, Service de Médecine Interne, Place Victor Pauchet , Amiens , France
| | - Nicolas Limal
- AP-HP, Hôpital Henri Mondor, Service de Médecine Interne , Créteil , France
| | - Laurent Perard
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Médecine Interne , Lyon , France
| | - Hélène Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Médecine Interne , Lyon , France
| | - Du Le Thi Huong
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Bouchra Asli
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Saint-Louis, Service d'Immunologie Clinique, 1 avenue Claude Vellefaux , Paris , France
| | - Jean-Emmanuel Kahn
- Université Versailles-Saint-Quentin-en-Yvelines, Hôpital Foch, Service de Médecine Interne , Suresnes, Cedex , France
| | - Laurent Sailler
- Université Paul-Sabatier , Toulouse , France ; CHU Toulouse, Hôpital Purpan, Service de Médecine Interne, Place Dr Baylac , Toulouse , France
| | - Félix Ackermann
- Université Versailles-Saint-Quentin-en-Yvelines, Hôpital Foch, Service de Médecine Interne , Suresnes, Cedex , France
| | - Thomas Papo
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Bichat Claude-Bernard, Service de Médecine Interne , Paris , France
| | - Karim Sacré
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Bichat Claude-Bernard, Service de Médecine Interne , Paris , France
| | - Olivier Fain
- Université Paris Nord , Sorbonne Paris Cité , France ; AP-HP, Hôpital Jean-Verdier, Service de Médecine Interne , Bondy , France
| | - Jérôme Stirnemann
- Université Paris Nord , Sorbonne Paris Cité , France ; AP-HP, Hôpital Jean-Verdier, Service de Médecine Interne , Bondy , France
| | - Patrice Cacoub
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Gaëlle Leroux
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Médecine Interne 1, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Judith Cohen-Bittan
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Jean-Sébastien Hulot
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Pharmacologie , Paris, Cedex , France
| | - Philippe Lechat
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Pharmacologie , Paris, Cedex , France
| | - Lucile Musset
- AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire d'Immunochimie, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Jean-Charles Piette
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Zahir Amoura
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Jean-Claude Souberbielle
- Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Necker-Enfants Malades, Laboratoire de Physiologie , Paris , France
| | - Nathalie Costedoat-Chalumeau
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
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Shaharir SS, Ghafor AHA, Said MSM, Kong NCT. A descriptive study of the factors associated with damage in Malaysian patients with lupus nephritis. Lupus 2014; 23:436-42. [DOI: 10.1177/0961203313518624] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Renal involvement is the most common serious complication in patients with systemic lupus erythematosus (SLE). Objective The objective of this article is to investigate and determine the associated factors of disease damage among lupus nephritis (LN) patients. Methods Medical records of LN patients who attended regular follow-up for at least one year in the Nephrology/SLE Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), were reviewed. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scores were noted. Univariate analysis and multivariable regression analysis were performed to determine the independent factors of disease damage in LN. Results A total of 150 patients were included and their follow-up duration ranged from one to 20 years. Sixty (40%) LN patients had disease damage (SDI ≥1). In the univariate analysis, it was associated with age, longer disease duration, antiphospholipid syndrome (APS), higher maximum daily oral prednisolone dose (mg/day), lower mean C3 and C4, higher chronicity index and global sclerosis on renal biopsies ( p < 0.05). Patients who received early (≤3 months after the SLE diagnosis) hydroxychloroquine (HCQ), optimum HCQ dose at 6.5 mg/kg/day and achieved early complete remission (CR) were less likely to have disease damage ( p < 0.05). After adjustment for age, gender, disease duration and severity, multivariable regression analysis revealed that a higher maximum daily dose of oral prednisolone was independently associated with disease damage while early HCQ and CR were associated with lower disease damage. Conclusion Higher maximum daily prednisolone dose predicted disease damage whereas treatment with early HCQ and early CR had a protective role against disease damage.
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Affiliation(s)
- SS Shaharir
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - AH Abdul Ghafor
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - MS Mohamed Said
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - NCT Kong
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Zou YF, Xu JH, Wang F, Liu S, Tao JH, Cai J, Lian L, Xiao H, Chen PL, Tian G, Wu M, Wang DG, Liu SX, Liang CM, Pan FM, Su H, Pan HF, Ye DQ. Association study of glucocorticoid receptor genetic polymorphisms with efficacy of glucocorticoids in systemic lupus erythematosus: A prospective cohort study. Autoimmunity 2013; 46:531-6. [DOI: 10.3109/08916934.2013.830714] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Costedoat-Chalumeau N, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Boutin DLTH, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Jallouli M, Leroux G, Cohen-Bittan J, Tanguy ML, Hulot JS, Lechat P, Musset L, Amoura Z, Piette JC. Hydroxychloroquine in systemic lupus erythematosus: results of a French multicentre controlled trial (PLUS Study). Ann Rheum Dis 2012; 72:1786-92. [DOI: 10.1136/annrheumdis-2012-202322] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sacre K, Criswell LA, McCune JM. Hydroxychloroquine is associated with impaired interferon-alpha and tumor necrosis factor-alpha production by plasmacytoid dendritic cells in systemic lupus erythematosus. Arthritis Res Ther 2012; 14:R155. [PMID: 22734582 PMCID: PMC3446541 DOI: 10.1186/ar3895] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/17/2012] [Accepted: 06/27/2012] [Indexed: 12/11/2022] Open
Abstract
Introduction Plasmacytoid dendritic cells (pDCs) constitutively express two members of the Toll-like receptor (TLR) family, TLR-9 and TLR-7, through which they can be stimulated to produce high levels of interferon (IFN)-α, a key mediator of the pathogenesis of systemic lupus erythematosus (SLE). Given the known efficacy of hydroxychloroquine (HCQ) in the treatment of SLE, we examined its ability to inhibit such pDC function in vivo. Methods Peripheral blood mononuclear cells (PBMCs) from SLE subjects treated or not with HCQ and from healthy controls were stimulated with the TLR-9 agonist, CpG oligodeoxynucleotides (CpG-A ODN)-2216, and the TLR-7 agonist, imiquimod. The proportion of monocytes, B cells, myeloid dendritic cells, pDCs, and natural killer (NK) cells producing IFN-α and tumor necrosis factor alpha (TNF-α) was then analyzed by multiparameter flow cytometry. Results After TLR-9/7 stimulation in both SLE and healthy subjects, significant production of IFN-α and TNF-α was only observed in pDCs. TLR-7 and TLR-9 induced IFN-α and TNF-α production by pDCs from subjects with SLE was decreased relative to that found in controls (TLR-9/IFN-α, P < 0.0001; TLR-9/TNF-α P < 0.0001; TLR-7/TNF-α P = 0.01). TLR-9 and TLR-7 induced IFN-α and TNF-α production by pDCs was severely impaired in 36% (TLR-9) and 33% (TLR-7) of SLE subjects. In almost all cases, these subjects were being treated with HCQ (HCQ vs. no HCQ: impaired TLR-9/IFN-α, P = 0.0003; impaired TLR-7/IFN-α, P = 0.07; impaired TLR-9/TNF-α, P < 0.009; impaired TLR-7/TNF-α, P < 0.01). Conclusions Treatment with HCQ is associated with impaired ability of pDCs from subjects with SLE to produce IFN-α and TNF-α upon stimulation with TLR-9 and TLR-7 agonists.
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Affiliation(s)
- Karim Sacre
- Department of Medicine, Division of Experimental Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA
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The association of systemic lupus erythematosus and myasthenia gravis: a series of 17 cases, with a special focus on hydroxychloroquine use and a review of the literature. J Neurol 2011; 259:1290-7. [PMID: 22160434 DOI: 10.1007/s00415-011-6335-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/16/2011] [Accepted: 11/17/2011] [Indexed: 01/19/2023]
Abstract
The coexistence of systemic lupus erythematosus (SLE) and myasthenia gravis (MG) is rarely reported, and most of the published studies are case reports. Hydroxychloroquine, an antimalarial agent, is an essential treatment in patients with SLE but special caution is recommended when used in MG patients. We retrospectively analyzed the clinical features, laboratory findings, and outcome of 17 patients with both diseases with a special focus regarding hydroxychloroquine use and with a review of the literature. All patients were women. The mean age at MG onset and SLE diagnosis was 34.5 [14-64] and 37.8 [18-72] years, respectively. The presenting symptoms of MG were limb weakness (94%), ocular (88%) and bulbar involvement (53%). Autoantibodies against the acetylcholine receptor were positive in 94% of cases. The main manifestations of SLE included arthritis (88%), cytopenias (53%) and skin rash (41%). Treatment of SLE required hydroxychloroquine (94%), steroids (47%) and immunosuppressive drugs (18%). Among eight patients (47%) who developed MG after initiation of hydroxychloroquine, the question of induction of MG by hydroxychloroquine was raised in one patient. On the other hand, an exacerbation of myasthenic symptoms was only seen in one of the eight patients who received hydroxychloroquine after the diagnosis of MG. Including our cases, we reviewed a total of 70 patients with SLE and MG. Compared with a large series of 1,000 unselected SLE patients, those with associated MG were older, had lower incidence of cutaneous, renal, and neurological manifestations, and higher frequency of anticardiolipin antibodies and lupus anticoagulant. In conclusion, the clinical pattern of patients with SLE and MG seems to be characterized by a less severe course of SLE and higher frequency of antiphospholipid antibodies. Hydroxychloroquine treatment appears to be safe in this setting.
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Sticherling M. Update on the use of topical calcineurin inhibitors in cutaneous lupus erythematosus. Biologics 2011; 5:21-31. [PMID: 21383913 PMCID: PMC3044791 DOI: 10.2147/btt.s9806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Indexed: 11/23/2022]
Abstract
Cutaneous manifestations of lupus erythematosus (CLE) are manifold, presenting with unspecific skin manifestations or well-defined clinical dermatological entities. Their relation to each other as well as to systemic lupus erythematosus is variable, yet diagnostically and therapeutically challenging. Therapeutic decisions have to be based on the activity and distribution as well as the type of skin lesions and the extent of systemic disease. Limited skin manifestations may be amply tackled by topical therapy, so far, mainly relying on corticosteroids. In many cases, however, internal treatment has to be combined by using antimalarials, in addition to strict UV-protection. The advent of topical calcineurin inhibitors has contributed substantially to the armamentarium of external treatment options. By specifically interfering with intracytoplasmic signal transduction to activate the nuclear factor of activated T-cells (NF-AT), they are able to modulate various inflammatory mechanisms. The two available compounds, pimecrolimus and tacrolimus, do not induce the skin atrophy characteristic of corticosteroids. They have been studied in a number of case reports, but only in a few randomized, comparative studies. Both are well-tolerated, but differentially effective in the various subsets of CLE. Further studies are needed to directly compare the two compounds to each other, as well as to topical corticosteroids, before final recommendations can be made.
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Affiliation(s)
- Michael Sticherling
- Hautklinik, Universitätsklinikum, Erlangen (Clinic of Dermatology, University Hospitals of Erlangen), Erlangen, Germany
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Szymezak J, Ankri A, Fischer AM, Darnige L. Hydroxychloroquine : une nouvelle approche thérapeutique des manifestations thrombotiques du syndrome des antiphospholipides. Rev Med Interne 2010; 31:854-7. [DOI: 10.1016/j.revmed.2010.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 08/13/2010] [Accepted: 08/21/2010] [Indexed: 10/19/2022]
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Costedoat-Chalumeau N, Amoura Z, Marra D, Piette JC. Hydroxychloroquine blood assay as a marker of nonadherence in patients with systemic lupus erythematosus: comment on the article by Koneru et al. ARTHRITIS AND RHEUMATISM 2008; 59:153-154. [PMID: 18163410 DOI: 10.1002/art.23257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Sticherling M, Bonsmann G, Kuhn A. Diagnostic approach and treatment of cutaneous lupus erythematosus. J Dtsch Dermatol Ges 2008; 6:48-59. [DOI: 10.1111/j.1610-0387.2007.06557.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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