Formulasi Klinis Dan Laboratoris Untuk Menentukan Respon Terapi Metilprednisolon Dosis Pulse Pada Lupus Eritematosus Sistemik

Ayu Paramaiswari, Prof.Dr.dr Nyoman Kertia,SpPD-KR.; Dr.dr Umi Solekhah Intansari,M Kes,SpPK(K)

2023 | Disertasi | S3 Kedokteran Umum

Latar Belakang: Metilprednisolon (MEP) pulse pada LES dipakai sebagai terapi induksi dalam mengatasi kekambuhan aktifitas penyakit dan memberikan perbaikan prognosis yang dramatis pada lupus berat. Beberapa penelitian menunjukkan bahwa respon komplit tercapai pada kurang dari 50% pasien. Mengetahui prediktor yang dapat mempengaruhi keberhasilan respon terapi MEP diperlukan untuk meningkatkan keberhasilan evaluasi dan terapi. Nilai SLEDAI dipakai untuk batasan memulai terapi MEP pulse , tetapi tidak bisa menentukan pada nilai berapa bisa memprediksi keberhasilan respon terapi. Diperlukan penggabungan dengan faktor-faktor lain sebagai prediktor keberhasilan terapi. Nilai SLEDAI 2K, SDI, RNL, IP 10, dan BAFF banyak dihubungkan dengan aktivitas LES, mortalitas, dan keberhasilan terapi pada LES. Tujuan penelitiaan: Menganalisis nilai SLEDAI 2K, SDI, RNL, kadar IP 10 dan BAFF untuk memformulasikan sistem penilaian prediktor respon terapi metil- prednisolon pulse pada LES. Metode: Disain penelitian kohort prospektif. Pasien LES di bangsal rawat inap RSUP Dr Sardjito yang memenuhi kriteria inklusi dan eksklusi dilakukan sampling secara konsekutif. Dilakukan pengukuran nilai SLEDAI 2K, SDI, RNL, kadar IP-10, dan BAFF. Kadar IP-10 dan BAFF terlarut diperiksa dengan metoda ELISA sedangkan reseptor BAFF dengan flowcytometri. Pasien dikelompokan atas SRI 50 non responder dan responder. Jumlah sampel minimal 83. Dilakukan analisis univariat, bivariat, dan multivariat untuk memformulasikan prediktor respon terapi MEP pulse. Hasil Penelitian: Seratus pasien LES berat yang mendapat MEP pulse, 80 diantaranya dilakukan analisis. Usia rerata 28 tahun, wanita sebanyak 97%. Rerata Nilai SLEDAI 2K adalah 30,04; SDI 0 (58%), SDI1 (18%); SDI 2 (6%); RNL 6,82.103/L; IP-10 367,34 pg/ml; kadar BAFF terlarut 2420,25 pg/ml; MFI R BAFF 4337,76; R BAFF 78,63%. Perbaikan respon terapi rerata adalah 36%. Didapatkan beda proporsi SRI 36 NR menurut kelompok SLEDAI 2K <= 24 dan > 24 serta R BAFF >= 59,1 dan < 59 xss=removed p=0,03).Tidak>5 mempunyai sensitifitas 93 dan spesifisitas 73 dengan RR:8 untuk terjadinya SRI 36 NR, p =< 0>

Background: Pulse dose methylprednisolone (MEP) in SLE is used as induction treatment to overcome disease flare and shows dramatic response in severe flare. However several researches show that complete response are reached in only less than 50% of patients. Determining predictors that can affect successfullness treatment response of pulse dose MEP will lead to better SLE management. SLEDAI Score has been extensively used as a tool to start MEP pulse dose but still doesnt tell at what number will predict the treatment response. It is presumed that other factors can serve as predictors of treatment response. SLEDAI 2K and SDI score, level of NLR, IP10, and BAFF has been corellated with disease activity , mortality, and other drug treatment response in some researches. Objective: To analyse SLEDAI 2K and SDI score, level of NLR, IP 10, and BAFF to formulate scoring system to predict treatment respons of pulse dose MEP. Method: A prospective cohort study design. SLE in patients of Sardjito General Hospital who meet inclusion and exclutson criteria will be enrolled to the study by consecutive sampling. SLEDAI-2K and SDI will be measured. Blood will be withdrawn for NLR,IP-10, and BAFF level examination. Level of IP-10 and soluble BAFF will be measured by ELISA method where as BAFF R is by flowcytometri. Subject will be devided into two groups as SRI 50 non responder and responder. Minimum sample are 83. Univariate, bivariate, dan multivariate analysis will be done to formulate predictor of MEP pulse dose treatment response. Results: One hundred severe active SLE patients who undergo MEP pulse dose included in this research, 80 were analysed. Mean age was 28 years, 97% woman. Mean SLEDAI 2K was 30,04; SDI 0 (58%), SDI1 (18%); SDI 2 (6%); NLR 6,82; IP-10 367,34 pg/ml;BAFF s level was 2420,25 pg/ml; MFI BAFF R 4337,76; BAFF R 78,63%;. Average respons rate was 36%. There were proportion difference for SRI 36 NR according to SLEDAI 2K <= 24 and > 24; BAFF R >=59,1 and < 59 xss=removed xss=removed> 5 has 93 of sensitivity and 73 specificity, with RR: 8 for the occurrence of SRI 36 NR, p-value <0>

Kata Kunci : Sle,Pulse Dose Metylprednisolone,Scoring System, Respons Treatment,Baff,Cxcr10