Influence of various immunosupressive therapy schemes on the dynamics of clinical and immunological activity indexes in patients with system red lupus with antiphospholipid syndrome


DOI: https://dx.doi.org/10.18565/therapy.2019.6.19-26

Belyaeva I.B., Mazurov V.I., Belolipetskaya E.A., Lapin S.V., Tkachenko O.Yu., Guseva V.I., Inamova O.V.

1) I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia, St. Petersburg; 2) I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia; 3) Clinical rheumatological hospital No. 25, St. Petersburg
The aim of the study was to estimate the effect of various immunosuppressive therapy schemes, including the use of rituximab, at the clinical immunological activity and dynamics of antiphospholipid antibodies (AFA) in patients with systemic lupus erythematosus (SLE) and SLE with antiphospholipid syndrome (APS).
Material and methods. The study included 52 patients with active clinical course of SLE, which were divided into two groups: the main group – 26 patients with SLE and the presence of AFA, 19 patients of them had AFS; and control group – 26 patients with SLE without AFA. Groups were comparable by sex, age, duration, and disease activity.
Depending on the variant of treatment suppressing the activity of SLE, the patients of the main and control groups were divided into two subgroups: subgroup A received combined pulse therapy with methylprednisolone 1000 mg intravenously drip No. 3 and cyclophosphamide 1000 mg intravenously dropwise once-occuring. Two patients with SLE and APS received rituximab 1000 mg intravenously dropwise – two injections with an interval of two weeks. Subgroup B received prednisone inside 1 mg/kg/day for 4 weeks. Subsequently, all patients were prescribed to have a combination therapy inside: prednisone 0,5 mg /kg/day with a dose reduction to 0,2 mg/kg/day, plaquenil 200 mg/day and azathioprine 100 mg/day.
The clinical activity of SLE was assessed using the SELENA SLEDAI scale, the level of antibodies to double-stranded DNA, complement components, and AFA after 6 months of observation.
Result and conclusion. In the active clinical course of SLE and SLE with APS, the use of combined pulse therapy with methylprednisolone and cyclophosphamide, as well as rituximab, in contrast to oral inhibitory doses of prednisone in combination with hydroxychloroquine and azathioprine, leads to a significant decrease in the clinical and laboratory activity of the disease according to the SELENA SLEDAI scale and level AFA (antibodies to phosphatidylserine-prothrombin complex, annexin IgM and β2-glycoprotein I).
Keywords: antibodies to the phosphatidylserine-prothrombin complex, antibodies to annexin, antiphospholipid syndrome, antiphospholipid antibodies, immunosuppressive therapy, systemic lupus erythematosus, rituximab
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About the Autors

Irina B. Belyaeva, MD, professor of the Department of therapy and rheumatology named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia. Address: 191015, St. Petersburg, 41 Kirochnaya Str. Tel.: +7 (812) 273-93-98. E-mail: belib@mail.ru
Vadim I. Mazurov, MD, academician of the Russian Academy of Sciences, professor, head of the Department of therapy and rheumatology named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia, Chief physician of St. Petersburg. Address: 191015, St. Petersburg, 41 Kirochnaya Str. Tel.: +7 (921) 951-71-88. E-mail: vadim.mazourov@szgmu.ru
Elizaveta A. Belolipetskaya, graduate student of the Department of therapy and rheumatology named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia. Address: 191015, St. Petersburg, 41 Kirochnaya Str. Tel.: +7 (812) 273-93-98. E-mail: lisa_osutina@list.ru
Sergey V. Lapin, PhD, head of the laboratory for autoimmune diseases diagnostics of Acad. I.P. Pavlov First St. Petersburg state medical university of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str., building 28. E-mail: svlapin@mail.ru
Olga Yuryevna Tkachenko, immunologist at the Autoimmune disease diagnostic laboratory of the First St. Petersburg State medical University named after Acad. I.P. Pavlova of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str., building 28. E-mail: autoimmun@mail.ru
Veronika I. Guseva, immunologist at the Autoimmune disease diagnostic laboratory of Acad. I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str., building 28. E-mail: autoimmun@mail.ru
Oksana V. Inamova, PhD, Chief physician of Clinical Rheumatological Hospital No. 25. Address: 190068, St. Petersburg, 30 Bolshaya Podyachnaya Str. Tel.: +7 (812) 338-00-42. E-mail: b25@zdrav.spb.ru


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