Trends in use of hydroxychloroquine during pregnancy in systemic lupus erythematosus patients from 2001 to 2015

Abstract

Background Evidence suggests that continuing hydroxychloroquine (HCQ) during pregnancy in women with systemic lupus erythematosus (SLE) improves outcomes. We sought to describe time trends in the continuation, initiation, and duration of HCQ in a large population-based cohort of pregnant SLE women. Methods A cohort of pregnant women with SLE enrolled continuously in public (Medicaid, 2001-2010) or private (Optum Clinformatics, 2003-2015) health insurance between three months prior to conception and one month after delivery was identified. We assessed the proportion of women initiating or continuing HCQ and the duration of therapy during each calendar year in the study. Results A total of 5300 women with SLE were included. Of these, 852 (16.1%) were on HCQ treatment in the three-month period prior to their pregnancy. During pregnancy, the overall proportion of women with SLE taking HCQ increased from 12.4% in 2001 to 37.7% in 2015. Initiation of HCQ therapy during pregnancy increased from 2.7% in 2001 to 7.5% in 2010 ( p = 0.0002) (Medicaid) and from 4.9% in 2003 to 13.6% in 2015 ( p = 0.0001) (Clinformatics). Continuation of HCQ during pregnancy did not change significantly over time in either data set. The average cumulative day-supply of HCQ prescriptions during pregnancy increased from 37 days in 2001 to 77 days in 2010 ( p = 0.05) among HCQ initiators and from 79 days in 2001 to 125 days in 2010 ( p = 0.0009) among HCQ continuers in Medicaid. Among privately insured women, the average cumulative day-supply of HCQ prescriptions among HCQ continuers increased from 84 in 2004 to 163 in 2015 ( p = 0.0006) but did not change significantly among HCQ initiators. Conclusion The proportion of women initiating HCQ during pregnancy and the average cumulative day-supply of HCQ increased from 2001 to 2015. While these findings are encouraging, overall HCQ use during pregnancy remains low.

Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: A prospective cohort study

“…Due to its beneficial effects and good safety profile, the use of antimalarial drugs during gestation in women with SLE has increased in the present century. 51,52 Several studies have shown the beneficial effects of hydroxychloroquine on maternal-fetal outcomes, including decrease of lupus flares, prematurity rates, intrauterine growth restriction and even improvement in the rate of fetal loss. [53][54][55][56][57][58] However, information on the role of antimalarial drugs in preeclampsia is more limited.…”

Pre-Exposure Prophylaxis for COVID-19 in Pregnant Women

“…18 HCQ is recognized as being safe for use during pregnancy and breastfeeding, and this property is especially important for women in malaria-endemic regions. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] A study of 133 pregnant women with connective tissue disease found that HCQ was safe when compared to a control group. 24 Historically, HCQ has been used by rheumatologists and obstetricians to treat women with autoimmune disease to minimize flares and improve pregnancy outcome.…”

Pre-Exposure Prophylaxis for COVID-19 in Pregnant Women.

“…Reproductive immunologists have used HCQ to calm overactive immune systems with good outcomes in women who suffer from immunological pregnancy loss and/or failure. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Although HCQ has been criticized for prolonging the QT interval, numerous other medications are known to have a greater effect on this EKG parameter without significant clinical concerns, and the safety of HCQ in COVID-19 treatment trials involving nearly 3000 outpatients has recently been confirmed. [34][35][36]…”