Antimalarial treatment may have a time‐dependent effect on lupus survival: Data from a multinational Latin American inception cohort

Abstract

Objective. To evaluate the beneficial effect of antimalarial treatment on lupus survival in a large, multiethnic, international longitudinal inception cohort.Methods. Socioeconomic and demographic characteristics, clinical manifestations, classification criteria, laboratory findings, and treatment variables were examined in patients with systemic lupus erythematosus (SLE) from the Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohort. The diagnosis of SLE, according to the American College of Rheumatology criteria, was assessed within 2 years of cohort entry. Cause of death was classified as active disease, infection, cardiovascular complications, thrombosis, malignancy, or other cause. Patients were subdivided by antimalarial use, grouped according to those who had received antimalarial drugs for at least 6 consecutive months (user) and those who had received antimalarial drugs for <6 consecutive months or who had never received antimalarial drugs (nonuser).Results. Of the 1,480 patients included in the GLADEL cohort, 1,141 (77%) were considered antimalarial users, with a mean duration of drug exposure of 48.5 months (range 6-98 months). Death occurred in 89 patients (6.0%). A lower mortality rate was observed in antimalarial users compared with nonusers (4.4% versus 11.5%; P< 0.001). Seventy patients (6.1%) had received antimalarial drugs for 6-11 months, 146Drs.

Identification of clinical predictors of flare in systemic lupus erythematosus patients: a 24-month prospective cohort study

“…A similar approach was previously employed by Houssiau et al [16] to evaluate the time to renal flare in the MAINTAIN trial. The same approach has been used in prospective cohort studies to evaluate the risk of SLE organ damage and mortality [17,18]. We found a relatively low proportion of patients suffering flares as compared with other cohort studies [1,5,19].…”

Response to hydroxychloroquine in Japanese patients with systemic lupus erythematosus using the cutaneous lupus erythematosus disease area and severity index (CLASI)

“…When we recalculated the median (range) CLASI activity score of all 11 patients, it changed from 6.0 (0-12) to 5.0 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Response to antimalarials in 36 patients with lupus erythematosus tumidus was reported recently.…”

“…In a Spanish cohort it was shown that antimalarials reduced the risk of thrombosis by 72%, that of major infection by 94%, and that of death by 86% [5,6]. In a Latin American cohort it was shown that antimalarials reduced the risk of death, in a time-dependent manner, by 38% [7]. A recent systematic review concluded that, given the broad spectrum of beneficial effects and the safety profile of HCQ, it should be given to most patients with SLE during the whole N. Yokogawa course of the disease, irrespective of its severity, and be continued during pregnancy [8].…”

Hydroxychloroquine as an anti-thrombotic in antiphospholipid syndrome

“…HCQ lowers disease activity and inflammation in SLE, and it has been reported that early initiation of HCQ delays the onset and progression of disease and ameliorates overall survival [36][37][38][39][40][41][42].…”