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All Journal Medical Journal of Indonesia The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Adityo Susilo, Adityo
Divisi Tropik Infeksi, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia
Medicine & Pharmacology

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Hubungan Penggantian Imunosupresan Tidak Terencana dengan Aktivitas Penyakit Lupus Eritematosus Sistemik: Studi Kohort Retrospektif di RSUPN Dr. Cipto Mangunkusumo, Jakarta Amanda, Rosvitha; Koesnoe, Sukamto; Widhani, Alvina; Rinaldi, Ikhwan; Susilo, Adityo; Kurniawan, Juferdy; Putranto, Rudi; Karim, Birry
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Introduction. Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease with diverse clinical manifestations. Treatment stabilization is crucial for optimal disease control, but the consistency of immunosuppressive therapy may be affected by non-ideal conditions, including drug unavailability or adverse effects. This study aimed to assess the association between unplanned immunosuppressant switching and increased disease activity in SLE patients. Methods. A retrospective cohort study of SLE patients meeting the inclusion criteria, whose disease activity was evaluated using the MEX-SLEDAI score during immunosuppressant substitution. Participants were grouped into an exposed group undergoing unplanned immunosuppressant switching due to drug unavailability and a comparison group continuing maintenance therapy without switching. Disease activity was assessed using the MEX-SLEDAI score during follow-up. Results. A total of 213 SLE patients were included; 45 patients (21.1%) experienced increased disease activity. Unplanned immunosuppressant substitution was significantly associated with increased disease activity (RR 2.06; 95% CI 1.18–3.60; p=0.011), and remained significant after adjustment for confounders (aRR 1.82; 95% CI 1.05–3.15; p=0.034). Subgroup analysis showed most flares occurred within the first three months after substitution, and mycophenolate-containing replacement regimens were associated with a lower risk of increased disease activity (p=0.025). Conclusions. Unplanned immunosuppressant substitution is associated with increased disease activity in SLE patients. Close monitoring following switching is essential to maintain disease stability.
Co-Authors Achmad Fauzi Afistianto, Muhammad Fikri Alvina Widhani, Alvina Amanda, Rosvitha Annisa, Firda Birry Karim Bonar, Maruhum Bonar H Bramantya Wicaksana C Rinaldi A Lesmana C. Martin Rumende, C. Martin Ceva W. Pitoyo Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Cleopas Martin Rumende Cynthia Olivia Maurine Jasirwan Dewi Gathmyr Dono Antono Duindrahajeng, Bernadine Gracia E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edwin Wijaya Edwin Wijaya, Edwin Edy Rizal Wahyudi Erni J Nelwan, Erni J Erni Juwita Nelwan, Erni Juwita Esa, Dekta Filantropi Evy Yunihastuti Fachriza, Ihza Fauzar, Fauzar Firda Annisa Gabriella, Stacy Ginova Nainggolan Gurmeet Singh Hasan Maulahela Hasibuan, Anshari Saifuddin Herikurniawan Herikurniawan Herikurniawan, Herikurniawan Ihza Fachriza Ika Prasetya Wijaya Ikhwan Rinaldi Iris Rengganis Iris Rengganis Jasirwan, Chyntia OM Juferdy Kurniawan Kaka Renaldi Khie Chen Kuntjoro Harimurti Kusuma, Ni Nyoman Indirawati Kusumaningrum, Profitasari Leonard Nainggolan Maksum, Maradewi Maradewi Maksum Marcellus Simadibrata Mira Yulianti Mira Yulianti, Mira Muradi, Akhmadu Murdani Abdullah Myranda Zahrah Putri Nathanael, Jason Pasaribu, Adeline Pratiwi, Amalia Nur Putri, Myranda Zahrah Rino Alvani Gani Robert Sinto Robert Sinto Rudi Putranto Rumende, Cleopas Martin Martin Shakinah, Sharifah Siti Setiati Stacy Gabriella Suhendro Suwarto Suhendro Suwarto, Suhendro Sukamto Koesnoe Suzy Maria Syahidatul Wafa Syahidatul Wafa, Syahidatul Tagor, Alvin Telly Kamelia Wicaksana, Bramantya Widayat Djoko Santoso Widayat Djoko Santoso, Widayat Djoko Wismandari Wisnu Wulani, Vally Wulyo Rajabto Zulkifli Amin