The association between hydroxychloroquine use and future development of systemic lupus erythematosus in patients with primary Sjögren's syndrome

Abstract

Aim Hydroxychloroquine (HCQ), commonly used to treat patients with primary Sjögren's syndrome (pSS), has been shown to delay the development of systemic lupus erythematosus (SLE). This study aimed to explore the association between HCQ use and future development of SLE in pSS patients based on a nationwide nested case–control study. Method Based on the National Health Insurance Research Database of Taiwan, those patients who were diagnosed with SLE at least 1 year after the diagnosis of pSS were identified as cases. Matched controls were randomly selected from pSS patients without a later diagnosis of SLE in a 1:10 ratio. The odds ratios (ORs) of HCQ exposure between cases and controls were analyzed by unconditional logistic regression after adjustment for age. Results A cohort of 11 772 pSS patients were extracted from the database during the period from January 1, 2000 to December 31, 2010. A total of 111 (0.9%) pSS patients developed SLE during the follow‐up period. Most (79%) of them developed SLE within 5 years after the diagnosis of pSS. There was no significant difference in the odds of HCQ exposure between cases and controls, with an adjusted OR of 2.43 (95% CI: 0.73–8.05). Neither did we observe a significant difference in the odds of exposure to a higher average dose of HCQ (≥100 mg/d vs non‐exposed) between cases and controls in the sensitivity analysis. Conclusion Nearly 1% of pSS patients may develop SLE. HCQ use in pSS patients was not associated with a lower possibility of the future development of SLE.

Risk of uveitis in autoimmune diseases patients treated with hydroxychloroquine: A population‐based retrospective cohort study

“…Nevertheless, in severe cases, early intervention is essential to prevent complications. 11 Uveitis is a type of intraocular inflammation that is commonly associated with autoimmune diseases, and is thought to result from an immune-mediated attack on the uveal tract. 7 The pathogenesis of uveitis in autoimmune diseases is believed to be multifactorial, involving genetic, environmental, and immune factors.…”

“…In clinical practice, topical corticosteroids are the primary treatment for managing uveitis. Nevertheless, in severe cases, early intervention is essential to prevent complications 11 . Uveitis is a type of intraocular inflammation that is commonly associated with autoimmune diseases, and is thought to result from an immune‐mediated attack on the uveal tract 7 .…”

“…12,13 One of the main mechanisms of action of HCQ is the inhibition of toll-like receptors (TLRs), which can reduce the production of pro-inflammatory cytokines and chemokines. 11 Although previous reports have suggested that HCQ treatment may increase the risk of retinopathy, there is also evidence to suggest that HCQ can delay or prevent organ damage. 14 However, the specific information regarding the incidence rate or risk of retinal complications in the subgroup of uveitis patients treated with HCQ remains inconclusive.…”

“…Hydroxychloroquine (HCQ), an antimalarial drug, which is used by Disease‐Modifying Antirheumatic Drugs (DMARDs) to treat various rheumatic diseases, such as RA, SLE, and SS 12,13 . One of the main mechanisms of action of HCQ is the inhibition of toll‐like receptors (TLRs), which can reduce the production of pro‐inflammatory cytokines and chemokines 11 . Although previous reports have suggested that HCQ treatment may increase the risk of retinopathy, there is also evidence to suggest that HCQ can delay or prevent organ damage 14 .…”

Effect of hydroxychloroquine blood concentration on the efficacy and ocular toxicity of systemic lupus erythematosus

“…Multiple studies have shown that HCQ can reduce disease activity, prevent disease flares, decrease the long-term need for glucocorticoids (GCs), and benefit pregnant women in SLE patients. Furthermore, HCQ has been reported to have multiple comprehensive effects, including anti-thrombotic, hypoglycemic, lipid-lowering, and reduced risk of cardiovascular disease 3 , 4 . More importantly, HCQ can lower the mortality rate in patients with SLE 5 .…”