( 广 东 省 药 学 会 风 湿 免 疫 用 药 专 家 委 员 会 ) systemic lupus erythematosus SLE LN 30. 13 ~ 70. 41 /10 1 SLE 20 ~ 40 a SLE SLE 1 SLE SLE CTX * MMF CsA FK506 MTX LEF - * A SLE Belimumab anti- BAFF SLE * 2 1 SFDA SLE SLE 1 LN LN 玺 玺 Lupus Nephritis LN 玺 SLE Thomson Healthcare MI- CROMEDEX LN 3 SLE 2010 SLE 1 4 SLE & 5 CTX Endoxan SLE * CTX SLE LN LN & 630
2014 09 24 09 2 SLE SLE CTX MMF MTX LEF FK506 8 2 2. 1 SLE 1 1 10 mg /d 2 SLE 0. 5 ~ 1 mg kg - 1 d - 1 3 1 mg kg - 1 d - 1 2 8 4 500 ~ 1 000 mg /d 3 d 5 ~ 30 d 2012 SLE 2 ACR LN 2 Ⅲ /ⅣLN 1 3 d C 0. 5 ~ 1 mg kg - 1 d - 1 2. 2 LN 2. 2. 1 口 服 CTX CTX SLE < NIH 10 mg /d CTX 0. 5 ~ 1. 0 g /m 2 7. 5 ~ 100 mg 3 ~ 4 1 6 ~ 12 3 1 l ~ 2 2012 ACR 9 CTX / CTX 3 9 1 CTX 0. 5 g2 1 6 2012 / KDIGO LN 4 2 Ⅲ ⅣLN 2 CTX 3 CTX 1. 0 ~ 1. 5 mg kg - 1 GIOP d - 1 150 mg /d 2 ~ 4 4 CTX 0. 2 g 1 - - - 7 9 5 CTX SLE / 6 / CTX SLE CTX 50 3 - - SLE SLE LN CTX 1 1 ~ 2 10% 0. 5 mg kg - 1 d - 1 1 CTX 2013 EULAR LN 2 CTX Ⅲ/ⅣLN 631
mg SLE CTX 2010 1 SLE MTX CTX CTX SLE MTX 7. 5 ~ 15 mg / CTX MTX CTX MTX SLE MTX 9 SFDA FDA MTX SLE MMF 2. 2. 2 MMF MMF B 2 MTX MMF MTX Ⅲ/ⅣLN 24 MMF LN CTX CTX 2012 ACR LN 2 2012 KDIGO LN LN CTX 4 FK506 MMF 5-7 Ⅲ/ⅣLN LN MMF 7 10 FK506 LN ⅤLN > 3 g /24 6 CTX FK506 h 0. 5 mg kg - 1 d - 1 MMF A Thomson ClassⅡa ClassⅡb 2. 2. 4 FK506 FK506 CsA 10 ~ 100 SLE Thomson Healthcare MICROMEDEX FK506 SLE CTX MMF LN FK506 24 3 ~ 6 mg /dfk506 MMF ACR CsA MMF MMF 2 g 3 C 2 8 2008 EULAR SLE 2. 2. 5 沙 利 度 胺 SLE TNF-α IL-8 IL-12 MMF 8 MMF SLE 2010 Thomson Healthcare MICROMEDEX 1 MMF LN SLE MMF 1 ~ 2 11 g /d2 2 MMF 50 ~ 100 mg /d MMF 3 ~ 6 30 d 1 2. 2. 6 苯 丁 酸 氮 芥 30 ~ 180 d DNA V 12 2. 2. 3 MTX 2008 EULAR 8 0. 1 ~ 0. 2 mg kg -1 d -1 8 ~ 12 SLE MTX 632
2014 09 24 09 Thomson Health- care MICROMEDEX 2010 1 IVIG 0. 4 g kg - 1 d - 1 3 ~ 5 d 1 2. 2. 7 长 春 新 碱 2. 4 RNA B 4 ~ 12 SLE B B 62% 13 0. 03 ~ 1. 4 mg m 2 w - 1 2 mg 4 1 LN CTX MMF SLE SLE Thomson Healthcare MICROMEDEX mg /m 2 1 4 1 000 mg 2 1 14 2. 3 IVIG SLE CD20 / 2012 ACR 2 6 375 30 ~ 120 min 2 SLE * ** Thomson 0. 75 mg / FDA 0. 75 mg 5 mg Thomson ClassⅡa Ⅱa - Category B Thomson Class Ⅱ b Class Ⅱb Category B / CTX 1. 0 ~ 1. 5 FDA CTX 50 mg mg kg - 1 d - 1 SLEThomson 150 mg /d ClassⅡa Ⅱb Category B 0. 5 g / 1 ~ 2 g /d2 FDA MMF 0. 25 g / LN Thomson 0. 25 g / ClassⅡa ClassⅡa Category B Thomson Class Ⅱa ClassⅡa Category B 633
2 / 2. 5 mg / 7. 5 ~ 15 mg / FDA MTX / 5 mg SLEThomson 0. 1 g 1 g Class Ⅱa Class Ⅱb 5 mg /1 ml 10 mg / 1 ml 50 mg /5 ml 0. 5 g /5 ml 1 g /10 Category B ml 5 g /50 ml 0. 5 mg / 3 ~ 6 mg /d FDA SLE MICROMEDEX SLE 25 mg / 50 ~ 100 mg /d FDA LEThomson Class Ⅱa Class Ⅱb Category B 1. 2. 2 mg / 0. 1 ~ 0. 2 mg 3. kg - 1 d - 1 8 ~ 12 FDA SLE MICROMEDEX SLE 1 mg 0. 03 ~ 1. 4 mg m 2 MICROMEDEX w - 1 SLE 2 mg ClassⅡ b Class Ⅱb Category C FDA 1. 0. 5 g /10 ml 1 g / 0. 4 g kg - 1 d - 1 FDA X 20 ml 1. 25 g /25 3 ~ SLEThomson ml 2. 5 g /50 ml 5 G 2. g /100 ml 10 g /200 5 d 1 Class Ⅱb Class Ⅱb Category B ml IgG 5% 3. 1. 100 mg /10 ml 375 mg /m 2 FDA B C 500 mg /50 ml 1 D B 4 1 000 2. mg 2 SLE Thomson CD20 Ⅲ ~ Ⅳ CVP 8 3. CD20 B DLBCL CHOP 8 1 Class Ⅱb Class Ⅱb Category B Thomson Class Ⅱa Class Ⅱ b Category B SLE * 1 2 48 ** Thomson Healthcare MICROMEDEX 634
2014 09 24 09 附 : 关 于 依 据 等 级 的 说 明 SFDA Category A 2 Category B 3 Thomson 4 Category C 3 No Evidence 5 4 A 5 B C 4 5 1. J. 2010 14 5342-3 346. 2Hahn BHMcMahon MAWilkinson Aet al. American College of Rheumatology guidelines for screeningtreatmentand management of lupus nephritisj. Arthritis Class Ⅰ Effective Care Res Hoboken 201264 6 797-808. ClassII a 3Duru Nvan der Goes MCJacobs JWet al. EULAR Evidence Favors evidence-based and consensus-based recommendations on Efficacy the management of medium to high-dose glucocorticoid therapy in rheumatic diseases J. Ann Rheum Dis 201372 12 1905-1913. ClassⅡ b Evidence is Inconclusive Glomerulonephritis Work Group. KDIGO Clinical Practice 4Kidney Disease Improving Global Outcomes KDIGO Guideline for Glomerulonephritis J. Kidney Inter Suppl 20122 139-274. ClassⅢ Ineffective 5Dooley MAHogan SJennette Cet al. Cyclophosphamide therapy for lupus nephritis poor renal survival in black AmericansJ. Glomerular Disease Collaborative Network. Kidney Int199751 4 1188-1195. 4 6Appel GBContreras GDooley MAet al. Mycophenolate mofetil versus cyclophosphamide for induction treat- ment of lupus nephritis J. J Am Soc Nephrol 2009 Class I Recommended 5 1103-1112. 7Isenberg DAppel GBContreras Get al. Influence of ClassⅡ a race /ethnicity on response to lupus nephritis treatment Recommended In Most the ALMS study J. Rheumatology Oxford 201049 1 128-140. ClassⅡb Recommended 8Bertsias G Ioannidis JPBoletis J et al. EULAR recommendations In Some for the management of systemic lupus erythe- matosus. Report of a Task Force of the EULAR Standing ClassⅢ Committee for International Clinical Studies Including Not Recommended Therapeutics J. Ann Rheum Dis200867 2 195 - Class Indeterminate 205. 635
9Schiff MHJaffe JSFreundlich B. Head-to-headrandomisedcrossover study of oral versus subcutaneous methotrexate in patients with rheumatoid arthritis drug-exposure limitations of oral methotrexate at doses 15 mg may be overcome with subcutaneous administration J. Ann Rheum Dis201473 81549-1451. 10Chen WTang XLiu Qet al. Short-term outcomes of induction therapy with tacrolimus versus cyclophosphamide for active lupus nephritis A multicenter randomized clinical trial J. Am J Kidney Dis201157 2 235-244. 11Privette EDWerth VP. Update on pathogenesis and treatment of CLE J. Curr Opin Rheumatol. 201325 5 584-590. 12Mok CC. Therapeutic options for resistant lupus nephritis J. Semin Arthritis Rheum. 2006 36 2 71-81. 13. J. 2003 7 12 749-751. 14van Vollenhoven RFParodis ILevitsky A. Biologics in SLE towards new approachesj. Best Pract Res Clin Rheumatol201327 3 341-349. 636