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Use and withdrawal of immunosuppressors in primary Sjögren’s syndrome

1, 2, 3, 4

  1. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  2. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  3. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  4. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. gabyhm@yahoo.com

CER10180 Submission on line
2018 Vol.36, N°3 ,Suppl.112 - PI 0177, PF 0181
Treatment

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Rheumatology Article

 

Abstract

OBJECTIVES:
To assess the use and causes of withdrawal of glucocorticoids and immunosuppressors among patients with primary Sjögren’s syndrome (pSS) in the clinical setting.
METHODS:
We retrospectively reviewed the medical records of 155 pSS patients and registered demographics, glandular/extraglandular features, serological data, cumulative ESSDAI and SSDDI. A single rheumatologist attributed the indication and cause of withdrawal of glucocorticoids and immunosuppressors.
RESULTS:
92.2% of the patients were female, mean age 57.4±14.7 years and median follow-up 11 years. One hundred and four (67%) patients received glucocorticoids and/or immunosuppressors: 3.8% only glucocorticoids, 43.9% only immunosuppressors and 56.5% their combination. The most used drugs were antimalarials (46.4%), prednisone (36.7%), azathioprine (AZA) (23.8%) and methotrexate (MTX) (18%). At the multivariate analysis, the presence of non-erosive arthritis OR 5.02 (95% CI 1.74–14.47, p=0.003) and the median cumulative ESSDAI score OR 1.10 (95% CI 1.03–1.17, p=0.002) were associated with the use of these drugs. The causes of withdrawal were: 39% improvement, 35.2% patient’s own decision, 18.1% toxicity and 11% lack of efficacy. We found toxicity in 14.2% MTX users, 9.7% for AZA, 9.7% for antimalarials and 7.6% for cyclophosphamide.
CONCLUSIONS:
More than half the patients received glucocorticoids and/or immunosuppressors and a not negligible number decided on their own to suspend them, alerting physicians of secondary adverse events and tolerability.

PMID: 28421999 [PubMed]

Received: 13/12/2016 - Accepted : 27/02/2017 - In Press: 18/04/2017 - Published: 14/08/2018