EVALUATION OF EFFICIENCY AND SAFETY OF DISEASE-MODIFYING ANTIRHEUMATIC DRUGS IN SYSTEMIC LUPUS ERYTHEMATOSUS
Summary. Abstract. Despite the available range of drugs for the treatment of systemic lupus erythematosus (SLE), the issue of controlling this disease has not been fully resolved. The development and implementation of immunobiological and targeted synthetic drugs is slower than in other rheumatologic diseases. Objectives. The purpose of the research lies in as follows: analysing the frequency of using disease-modifying antirheumatic drugs (DMARDs) in SLE (hydroxychloroquine, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, rituximab); defining types and prevalence of side effects, reasons for drug discontinuation and therapy survival; assessing the impact of the age of onset and the duration of delay in the diagnosis of SLE on these parameters. Based on the data obtained, conclusions concerning possible ways to optimize SLE therapy have to be drawn up. Materials and methods. A retrospective analysis of the medical records of 153 patients who had been treated at the State Institution «National Scientific Centre «Institute of Cardiology named after academician M.D. Strazhesko» of NAMS of Ukraine in the period from 2011 to 2021 was conducted, as well as a survey of 45 of them was performed in order to clarify the information received. Survival of therapy was analysed by using Kaplan-Meyer curves. Correlation relationships were studied by Spearman’s rank correlation method. Results. It has been revealed that the survival rate of Mycophenolate mofetil therapy is the highest compared to other synthetic DMARDs, and the number of side effects is the lowest. Concurrently, side effects have been found to be the main reason for the discontinuation of azathioprine; they are mostly mild or moderate, which differs significantly from the scientific literature data. As a result of the analysis conducted, it was further confirmed that in the group of patients who had been treated with Hydroxychloroquine (in addition to other drugs), there was a significantly longer period prior to the onset of an exacerbation compared to patients who hadn’t been taken this drug. Furthermore, a moderate negative correlation has been found between the age of SLE onset and the average duration of DMARDs therapy, which may indicate a better response to therapy in young patients. Conclusions. Mycophenolate mofetil can be considered as a priority drug for treatment patients with a high burden of comorbidities and an increased risk of side effects. In case of mild and moderate adverse events of DMARDs, attempts should be made to restore the drug or adjust the dose, and only if they are ineffective, the drug should be discontinued. Hydroxychloroquine should be prescribed to all patients in case of absence of contraindications.
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