PMID- 36969501
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230328
IS  - 2040-6223 (Print)
IS  - 2040-6231 (Electronic)
IS  - 2040-6223 (Linking)
VI  - 14
DP  - 2023
TI  - Risk factors of significant relapse and appropriate maintenance therapy strategy 
      in SLE-associated immune thrombocytopenia.
PG  - 20406223231160688
LID - 10.1177/20406223231160688 [doi]
LID - 20406223231160688
AB  - BACKGROUND: Systemic lupus erythematosus-associated immune thrombocytopenia 
      (SLE-ITP) is characterized by relapse. The risk factors of relapse and 
      appropriate maintenance therapy strategy deserve further exploration. OBJECTIVES: 
      To determine the risk factors for relapse and appropriate maintenance therapy in 
      significant SLE-ITP patients (a platelet count ⩽30 x 10(9)/l) after the first 
      complete response. DESIGN: Retrospective cohort study using the medical records 
      of 105 patients diagnosed as significant SLE-ITP in Fujian Medical University 
      Union Hospital during December 2012 to March 2021. Patients were followed through 
      a call for observations in January 2022. METHODS: Data including demographics, 
      initial clinical feature, induction and maintenance therapy, and outcome at the 
      end of follow-up were analyzed. Risk factors for significant relapse were 
      analyzed using multivariate logistic regression models. The cumulative hazard of 
      significant relapse and the duration of response were estimated, and the 
      differences in outcome between groups were compared using the Cox regression 
      analysis. RESULTS: A total of 65 significant SLE-ITP patients were eligible for 
      the final analysis. Median [interquartile range (IQR)] follow-up duration and 
      median [IQR] duration of response were 62.2 [41.0-79.6] months and 43.4 
      [20.3-68.7] months, respectively. After the first complete response, 19/65 
      (29.2%) had a significant relapse. Compared with sustained clinical remission 
      (SCR) + sustained response (SR) group, significant relapse group had a higher 
      proportion of discontinued patients (47.4% versus 8.7%, p = 0.001). Among the 13 
      discontinued patients, the duration of maintenance therapy of the patients in 
      significant relapse group was significantly shorter than that of the patients in 
      SCR + SR group (months, median [IQR], 43.1 [32.0-62.4] versus 12.0 [5.1-22.0], 
      p = 0.009). Multivariate logistic regression analysis showed that drug withdrawal 
      was an independent risk factor for significant relapse [odds ratio (OR) = 10.4, 
      confidence interval (CI) 95% 2.2-47.8, p = 0.003]. There was no significant 
      difference between glucocorticoids (GCs) + hydroxychloroquine (HCQ) group and 
      GCs + HCQ + immunosuppressive agents (ISAs) group in significant relapse rate 
      (26.7% versus 22.2%, p > 0.05). The two SR curves of GCs + HCQ and GCs + HCQ+ ISA 
      group basically coincided by the Cox regression analysis, demonstrating 
      comparable long-term outcomes (p > 0.05). CONCLUSION: Drug withdrawal, especially 
      abrupt withdrawal with insufficient duration of maintenance therapy, is an 
      independent risk factor for significant relapse of SLE-ITP. HCQ combined with GCs 
      is expected to be the first choice of the maintenance therapy for SLE-ITP 
      patients.
CI  - (c) The Author(s), 2023.
FAU - Li, He-Jun
AU  - Li HJ
AUID- ORCID: 0000-0001-9179-8887
AD  - Department of Rheumatology, Fujian Medical University Union Hospital, 29 Xinquan 
      Road, Fuzhou 350001, China.
FAU - Zheng, Yi-Qing
AU  - Zheng YQ
AD  - Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, 
      China.
FAU - Chen, Ling
AU  - Chen L
AD  - Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, 
      China.
FAU - Lin, Shun-Ping
AU  - Lin SP
AD  - Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, 
      China.
FAU - Zheng, Xiang-Xiong
AU  - Zheng XX
AD  - Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, 
      China.
LA  - eng
PT  - Journal Article
DEP - 20230321
PL  - United States
TA  - Ther Adv Chronic Dis
JT  - Therapeutic advances in chronic disease
JID - 101532140
PMC - PMC10031598
OTO - NOTNLM
OT  - SLE-associated immune thrombocytopenia
OT  - hydroxychloroquine
OT  - immunosuppressive agents
OT  - maintenance therapy
COIS- The authors declared no potential conflicts of interest with respect to the 
      research, authorship, and/or publication of this article.
EDAT- 2023/03/28 06:00
MHDA- 2023/03/28 06:01
PMCR- 2023/03/21
CRDT- 2023/03/27 03:38
PHST- 2022/08/16 00:00 [received]
PHST- 2023/02/13 00:00 [accepted]
PHST- 2023/03/27 03:38 [entrez]
PHST- 2023/03/28 06:00 [pubmed]
PHST- 2023/03/28 06:01 [medline]
PHST- 2023/03/21 00:00 [pmc-release]
AID - 10.1177_20406223231160688 [pii]
AID - 10.1177/20406223231160688 [doi]
PST - epublish
SO  - Ther Adv Chronic Dis. 2023 Mar 21;14:20406223231160688. doi: 
      10.1177/20406223231160688. eCollection 2023.