Use and withdrawal of immunosuppressors in primary Sjögren's syndrome

Clin Exp Rheumatol. 2018 May-Jun;36 Suppl 112(3):177-181. Epub 2017 Apr 18.

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.

MeSH terms

  • Adult
  • Aged
  • Chi-Square Distribution
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / adverse effects
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / adverse effects
  • Logistic Models
  • Male
  • Medical Records
  • Medication Adherence
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Remission Induction
  • Retrospective Studies
  • Risk Factors
  • Sjogren's Syndrome / diagnosis
  • Sjogren's Syndrome / drug therapy*
  • Sjogren's Syndrome / immunology
  • Time Factors
  • Treatment Outcome

Substances

  • Glucocorticoids
  • Immunosuppressive Agents