THE EFFECT OF IMMUNOSUPPRESSIVE THERAPY ON CLINICAL AND IMMUNOLOGICAL ACTIVITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPIDIC SYNDROME

The purpose of this study was to evaluate the effect of various immunosuppressive regimens on the clinical and immunological activity and dynamics of antiphospholipid antibodies (AFA) in patients with systemic lupus erythematosus (SLE) with antiphospholipid syndrome (AFS). The study included 52 patients with active SLE, divided into two groups: the main group included 26 patients with SLE and AFA, of which 19 patients had APS; 26 patients with SLE without AFA were included in the control group. The groups were comparable by sex, age, duration and activity of the disease. Depending on the variant of therapy suppressing the activity of SLE, the patients of the main and control groups were divided into two subgroups: subgroup A received a combined pulse-therapy with methylprednisolone 1000 mg intravenously (IV) thrice and cyclophosphamide 1000 mg IVgiven as a single dose. Two patients with SLE and APS received rituximab 1000 mg IV 2 injections within 2 weeks of each other. Subgroup B received prednisolone per os at a dose of 1 mg/kg/day for 4 weeks. Subsequently, all patients were prescribed to receive combined therapy per os: prednisolone 0.5 mg/kg/day with a dose reduction of up to 0.2 mg/kg/day, plaquenil 200 mg/day, and azathioprine 100 mg/day. The evaluation of the clinical activity of SLE according to the SELENA SLEDAI scale, the level of antibodies to double-stranded DNA, complement components and AFA was carried out after 6 months of follow up. In case of the active course of SLE and SLE with AFS, the use of combined pulse therapy with methylprednisolone and cyclophosphamide, as well as rituximab, in contrast to the administration of oral suppressive doses of prednisolone in combination with plaquenil and azathioprine, leads to a significant decrease in the clinical and laboratory activity of the disease according to the SELENA SLEDAI scale, and decrease in AFA (aPS-Pt, anti-annexin IgM, and anti-β2-GP-I) levels. According to the results obtained, the use of combined pulse therapy with methylprednisolone and cyclophosphamide as well as rituximab leads to a reduction in the risk of thrombotic complications and an improvement in the prognosis of SLE.

systemic lupus erythematosus, antiphospholipid antibodies, antiphospholipid syndrome, immunosuppressive therapy, antibodies to phosphatidylserine-prothrombin complex, antibodies to annexin, rituximab