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dc.contributor.authorPego-Reigosa, Jose M.
dc.contributor.authorCobo-Ibanez, Tatiana
dc.contributor.authorCalvo-Alen, Jaime
dc.contributor.authorLoza-Santamaria, Estibaliz
dc.contributor.authorRahman, Anisur
dc.contributor.authorMunoz-Fernandez, Santiago
dc.contributor.authorRua-Figueroa, Inigo
dc.date.accessioned2017-06-07T07:05:00Z
dc.date.available2017-06-07T07:05:00Z
dc.date.issued2013
dc.identifier.issn2151-464X
dc.identifier.urihttp://hdl.handle.net/20.500.11940/2365
dc.description.abstractOBJECTIVE: To analyze the efficacy and safety of nonbiologic immunosuppressants in the treatment of nonrenal systemic lupus erythematosus (SLE). METHODS: We conducted a sensitive literature search in Medline, Embase, and the Cochrane Central Register of Controlled Trials up to October 2011. The selection criteria were studies including adult patients with SLE, a treatment intervention with nonbiologic immunosuppressants, a placebo or active comparator group, and outcome measures assessing efficacy and/or safety. Meta-analyses, systematic reviews, clinical trials, and cohort studies were included. The quality of each study was evaluated using Jadad's scale and the Oxford Levels of Evidence. RESULTS: In total, 158 of the 2,827 initially found articles were selected for detailed review; 65 studies fulfilled the predetermined criteria. Overall, the studies were low quality, with only 11 randomized controlled trials (RCTs). Cyclophosphamide demonstrated efficacy for neuropsychiatric SLE, preventing relapses with an additional steroid sparing effect, although its use was associated with cumulative damage, development of cervical intraepithelial neoplasia,and ovarian failure. Other immunosuppressants (azathioprine, methotrexate, leflunomide, mycophenolate mofetil,and cyclosporin A) demonstrated efficacy in reducing nonrenal activity and flares with a steroid-sparing effect, although only on occasion in non-placebo-controlled RCTs of small numbers of patients. CONCLUSION: Several immunosuppressants demonstrated their safety and efficacy in nonrenal SLE. A specific drug for each particular manifestation cannot be recommended, although cyclophosphamide may be used in more severe cases, and methotrexate may be the first option in most cases of moderately active SLE. High-quality RCTs of larger numbers of patients are needed.
dc.language.isoeng
dc.subject.meshHumans
dc.subject.meshImmunosuppressive Agents
dc.subject.meshLupus Erythematosus, Systemic
dc.subject.meshTreatment Outcome
dc.titleEfficacy and Safety of Nonbiologic Immunosuppressants in the Treatment of Nonrenal Systemic Lupus Erythematosus: A Systematic Review
dc.typeArtigoes
dc.authorsophosPego-Reigosa, Jose M.
dc.authorsophosCobo-Ibanez, Tatiana
dc.authorsophosCalvo-Alen, Jaime
dc.authorsophosLoza-Santamaria, Estibaliz
dc.authorsophosRahman, Anisur
dc.authorsophosMunoz-Fernandez, Santiago
dc.authorsophosRua-Figueroa, Inigo
dc.identifier.doi10.1002/acr.22035
dc.identifier.isi326133600005
dc.identifier.pmid23609987
dc.identifier.sophos13100
dc.issue.number11
dc.journal.titleARTHRITIS CARE & RESEARCH
dc.organizationServizo Galego de Saúde::Estrutura de Xestión Integrada (EOXI)::EOXI de Vigo - Complexo Hospitalario Universitario de Vigo::Reumatoloxía
dc.organizationServizo Galego de Saúde::Estrutura de Xestión Integrada (EOXI)::EOXI de Vigo::IBI - Instituto de Investigación Biomédica de Ourense, Pontevedra y Vigo
dc.page.initial1775
dc.page.final1785
dc.rights.accessRightsopenAccess
dc.typesophosArtículo Original
dc.volume.number65


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