Clinical Efficacy of Apremilast Combined with Hydroxychloroquine in the Treatment of Primary Sjögren's Syndrome
SHANG Changqing1, XU Ning1, ZHANG Jian1, LIU Haitao2
1. Department of Emergency, Tongling Municipal Hospital, Tongling 244000, China; 2. Department of Respiratory Medicine, Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
Abstract:Objective This study aimed to evaluate the clinical efficacy of Apremilast combined with Hydroxychloroquine in treating Primary Sjögren's Syndrome (PSS). Methods A retrospective study was conducted on 80 patients with primary Sjögren's Syndrome (PSS) treated at the Tongling City Hospital in Anhui Province from January 2019 to January 2023. Patients were divided into a combination therapy group (43 cases) who received treatment with Alramod combined with Hydroxychloroquine Sulfate tablets, and a control group (37 cases) who received Alramod alone. Clinical efficacy, salivary flow rate, tear secretion, Patient Reported Index in Sjögren's Syndrome (EULAR Sjögren's Syndrome Patient Reported Index, ESSPRI), Sjögren's Syndrome Disease Activity Index (EULAR Sjögren's Syndrome Disease Activity Index, ESSDAI), as well as levels of Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), and Immunoglobulin G (IgG) were observed in both groups. Additionally, the incidence of adverse reactions in both groups was monitored. Results After treatment, the total effective rate of the combination group was higher than that of the control group; the saliva flow rate, tear secretion, ESSPRI, and ESSDAI scores of the combination group were better than those of the control group; the levels of ESR, CRP, and IgG in patients of the combination group were lower than those in the control group; there was no statistically significant difference in the incidence of adverse reactions between the two groups. Conclusion The combination of Elamod and Hydroxychloroquine Sulfate Tablets in the treatment of patients with primary Sjogren's Syndrome can significantly improve saliva and tear secretion, reduce inflammatory indicators, and has good safety, providing an effective combination therapy for the treatment of PSS.
[1] KACHANER A, BERGÉ E, DESMOULINS F, et al.Comparison between primary Sjögren's disease patients with high or low level of dryness[J]. RMD open, 2023, 9(4) : e003291. [2] DONG X, GAO Y, LI M, et al.The characteristics of chest HRCT and pulmonary function tests in lung‐onset primary sjogren's syndrome[J]. Immun Inflamm Dis, 2023, 11(8) : e957. [3] KHALAYLI N, BOURI M F, WAHBEH M, et al.Neurological injury in primary Sjogren's syndrome[J]. Ann Med Surg, 2023, 85(7) : 3381-3385. [4] LI P, JIN Y, ZHAO R, et al.Expression of ICOS in the salivary glands of patients with primary Sjogren's syndrome and its molecular mechanism[J]. Mol Med Rep, 2022, 26(5) : 1-11. [5] AIELLO F, BALZANO F, BARRETTA G U, et al.Chiral distinction between hydroxychloroquine enantiomers in binding to angiotensin-converting enzyme 2, the forward receptor of SARS-CoV-2[J]. J Pharm Biomed Anal, 2024, 237: 115770. [6] WANG S, YU J, YANG J, et al.Effects of iguratimod on inflammatory factors and apoptosis of submandibular gland epithelial cells in NOD mice[J]. Sci Rep, 2023, 13(1) : 18205. [7] 邵苗, 张学武. 2015年欧洲抗风湿病联盟/美国风湿病学会痛风分类新标准[J]. 中华风湿病学杂志, 2015, 19(12) : 854-855. [8] 梁爽, 姚胜, 高紫欣, 等. 艾拉莫德与羟氯喹治疗原发性干燥综合征有效性和安全性比较的系统分析[J]. 中国免疫学杂志, 2022, 38(5) : 591-598. [9] ZHONG H, XUE Y, ZHANG L, et al.Predictive value of bone marrow megakaryocyte count for immunotherapeutic response in primary Sjögren's syndrome patients with severe immune thrombocytopenia: A single‐center case-control study in China[J]. Int J Rheum Dis, 2023, 26(7) : 1260-1267. [10] ZHANG J, ZHANG X, SHI X, et al.CXCL9, 10, 11/CXCR3 Axis Contributes to the Progress of Primary Sjogren's Syndrome by Activating GRK2 to Promote T Lymphocyte Migration[J]. Inflammation, 2023, 46(3): 1047-1060. [11] FELTEN R, MEYER A, GOTTENBERG J E.Non-primary Sjogren's Syndrome: Secondary or associated?[J]. Joint Bone Spine, 2023, 90(2) : 105502. [12] MA J P, SARICI K, IANNACCONE A, et al.Autoimmune-related retinopathy presenting as plaquenil toxicity in patients with systemic lupus erythematosus[J]. J Vitreoretin Dis, 2023, 7(6) : 521-527. [13] BISWAS M, SUKASEM C.Pharmacogenomics of chloroquine and hydroxychloroquine: current evidence and future implications[J]. Pharmacogenomics, 2023, 24(15) : 831-840. [14] WANG S, XIE W.A prospective observational cohort study of the efficacy of tofacitinib plus iguratimod on rheumatoid arthritis with usual interstitial pneumonia[J]. Front Immunol, 2023, 14: 1215450. [15] 邹瑶, 肖伟, 李丽华, 等. 艾拉莫德治疗原发性干燥综合征的临床应用及作用机制[J]. 中国新药杂志, 2022, 31(23) : 2329-2332. [16] 王雪, 袁祥, 王其凯, 等. 艾拉莫德对原发性干燥综合征的治疗作用及其机制[J]. 中华疾病控制杂志, 2018, 22 (1) : 75-78+84. [17] 房艳华, 黄建峰. 艾拉莫德治疗原发性干燥综合征疗效及安全性的Meta分析[J]. 海南医学, 2020, 31(10) : 1332-1338. [18] 李传静, 李锐, 刘汉忠, 等. 甲泼尼龙联合艾拉莫德治疗原发性干燥综合征疗效及对免疫球蛋白水平的影响[J]. 中国药业, 2018, 27(14) : 35-37. [19] 上官雪丽, 周牧之, 柳玉佳, 等. 燥痹汤联合硫酸羟氯喹片治疗原发性干燥综合征肺胃阴虚证临床研究[J]. 中国中医药信息杂志, 2023, 30(11) : 173-177. [20] 李君, 肖俊. 承气养荣汤加减对原发性干燥综合征患者唾液腺和泪腺分泌功能及ESR、CRP、IgG的影响[J]. 现代中西医结合杂志, 2020, 29(18) : 2016-2019. [21] 吴晓畅, 王领, 张娜, 等. 艾拉莫德对干燥综合征模型小鼠的影响[J]. 实用医学杂志, 2018, 34(22) : 3700-3704. [22] 吴子华, 黄子玮, 陈嘉琪, 等. 化湿润燥方治疗原发性干燥综合征的临床疗效[J]. 中国实验方剂学杂志, 2023, 29(8) : 45-51. [23] 吴嘉龙, 吴子昂, 钮晓音. 原发性干燥综合征的靶向治疗药物研究进展[J]. 生命科学, 2021, 33(10) : 1239-1245. [24] SANTOS C S, SALGUEIRO R R, MORALES C M, et al.Risk factors for cardiovascular disease in primary Sjögren's syndrome (pSS) : A 20-year follow-up study[J]. Clin Rheumatol, 2023, 42(11) : 3021-3031.