title: The efficacy of add-on tacrolimus for minor flare in patients with systemic lupus erythematosus: a retrospective study.
abstract: OBJECTIVE
  We have assessed the effectiveness of tacrolimus for minor flares in systemic lupus erythematosus (SLE) patients.
  
  
  METHODS
  The medical records of 313 patients were retrospectively reviewed over a period of seven years, from 2006 to 2013. We enrolled patients with minor flare treated with add-on tacrolimus, without glucocorticoid (GC) intensification (tacrolimus group). Minor flare was defined as a ≥ 1-point increase in a total score between 3 and 11 in the SLE Disease Activity Index (SLEDAI). We enrolled as controls patients who were administered increased doses of GC for minor flare (GC group). All patients were followed for one year. The primary outcome measure was the proportion of responders.
  
  
  RESULTS
  There were 14 eligible patients in the tacrolimus group and 20 eligible patients in the GC group. The mean SLEDAI at flare tended to be higher in the tacrolimus group than in the GC group (7.5 vs. 6.2, p = 0.085). A mean dose of 1.6 mg tacrolimus/day was administered for flare, while the mean GC dose was 13.7 mg/day in the GC group. The proportion of responders was 86% (12/14) in the tacrolimus group and 75% (15/20) in the GC group (p = 0.67). The mean dose of GC at 12 months was higher in the GC group than in the tacrolimus group (9.7 mg/day vs. 7.1 mg/day, p < 0.05). Only one patient discontinued tacrolimus because of fatigue after three months.
  
  
  CONCLUSIONS
  Adding tacrolimus without increasing the GC dose may provide an effective treatment option for minor flares in patients with SLE.
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: H
authors: H
authors: Watanabe
authors: Internal Medicine, Himeji Red Cross Hospital, Japan.
authors: R
authors: R
authors: Yamanaka
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan sadakenn@md.okayama-u.ac.jp.
authors: K-E
authors: KE
authors: Sada
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: S
authors: S
authors: Zeggar
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: E
authors: E
authors: Katsuyama
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: T
authors: T
authors: Katsuyama
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: M T
authors: MT
authors: Narazaki
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: N T
authors: NT
authors: Tatebe
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: K
authors: K
authors: Sugiyama
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: K S
authors: KS
authors: Watanabe
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: H
authors: H
authors: Wakabayashi
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: T
authors: T
authors: Kawabata
authors: Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors: J
authors: J
authors: Wada
authors: Okayama University Hospital, Japan.
authors: H
authors: H
authors: Makino
mesh_terms: D000328:Adult; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: Tacrolimus; minor flare; systemic lupus erythematosus