Safety and Efficacy of Switching Immunosuppressive Drugs for Maintenance Treatment in Patients with Systemic Lupus Erythematosus: A Retrospective Cohort Study

Mod Rheumatol. 2022 Aug 26;roac100. doi: 10.1093/mr/roac100. Online ahead of print.

Abstract

Objectives: To clarify the efficacy and safety of switching immunosuppressive drugs and to identify the predictive factors for treatment failure after switching in patients with systemic lupus erythematosus (SLE).

Methods: We retrospectively evaluated patients with SLE who switched immunosuppressive drugs for any reason in our hospital between 2015 and 2020. The efficacy endpoints were the change in SLE Disease Activity Index 2000 (SLEDAI) score, prednisolone dose, and disease status over 12 months, as well as treatment continuation rates. The safety endpoint was the frequency of adverse events over 1 year before and after switching. Cox hazard regression analyses were used to identify the predictive factors for treatment failure.

Results: Thirty-nine patients (age, 41.5±12.6 years; 35 women, 4 men) were analysed. The SLEDAI score and prednisolone dose were significantly reduced after switching, with few disease exacerbations over 12 months. The 1- and 2-year continuation rates were 71.4% and 62.3%, respectively. The frequency of adverse events was similar in the year before and after switching the drug. Drug switching due to inadequate efficacy was a predictive factor of less likely treatment failure.

Conclusions: Immunosuppressive drug switching led to reduced disease activity and decreased glucocorticoid dose without disease exacerbations and severe adverse events.

Keywords: continuation rate; drug switching; immunosuppressive drugs; mycophenolate mofetil; systemic lupus erythematosus; tacrolimus.