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Flares after hydrox...
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Almeida-Brasil, Celline C.McGill University Health Center
(author)
Flares after hydroxychloroquine reduction or discontinuation : results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
- Article/chapterEnglish2022
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LIBRIS-ID:oai:lup.lub.lu.se:da4fb61c-222b-4600-97ad-59488c39bf44
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https://lup.lub.lu.se/record/da4fb61c-222b-4600-97ad-59488c39bf44URI
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https://doi.org/10.1136/annrheumdis-2021-221295DOI
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Language:English
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Summary in:English
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Subject category:art swepub-publicationtype
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Subject category:ref swepub-contenttype
Notes
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OBJECTIVES: To evaluate systemic lupus erythematosus (SLE) flares following hydroxychloroquine (HCQ) reduction or discontinuation versus HCQ maintenance. METHODS: We analysed prospective data from the Systemic Lupus International Collaborating Clinics (SLICC) cohort, enrolled from 33 sites within 15 months of SLE diagnosis and followed annually (1999-2019). We evaluated person-time contributed while on the initial HCQ dose ('maintenance'), comparing this with person-time contributed after a first dose reduction, and after a first HCQ discontinuation. We estimated time to first flare, defined as either subsequent need for therapy augmentation, increase of ≥4 points in the SLE Disease Activity Index-2000, or hospitalisation for SLE. We estimated adjusted HRs (aHRs) with 95% CIs associated with reducing/discontinuing HCQ (vs maintenance). We also conducted separate multivariable hazard regressions in each HCQ subcohort to identify factors associated with flare. RESULTS: We studied 1460 (90% female) patients initiating HCQ. aHRs for first SLE flare were 1.20 (95% CI 1.04 to 1.38) and 1.56 (95% CI 1.31 to 1.86) for the HCQ reduction and discontinuation groups, respectively, versus HCQ maintenance. Patients with low educational level were at particular risk of flaring after HCQ discontinuation (aHR 1.43, 95% CI 1.09 to 1.87). Prednisone use at time-zero was associated with over 1.5-fold increase in flare risk in all HCQ subcohorts. CONCLUSIONS: SLE flare risk was higher after HCQ taper/discontinuation versus HCQ maintenance. Decisions to maintain, reduce or stop HCQ may affect specific subgroups differently, including those on prednisone and/or with low education. Further study of special groups (eg, seniors) may be helpful.
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Hanly, John G.Dalhousie University
(author)
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Urowitz, MurrayUniversity of Toronto
(author)
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Clarke, Ann ElaineUniversity of Calgary
(author)
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Ruiz-Irastorza, GuillermoHospital de Cruces
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Gordon, CarolineUniversity of Birmingham
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Ramsey-Goldman, RosalindNorthwestern University
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Petri, MichelleJohns Hopkins University
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Ginzler, Ellen M.SUNY Downstate Health Sciences University
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Wallace, D. J.University of California, Los Angeles
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Bae, Sang CheolHanyang University
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Romero-Diaz, JuanitaSalvador Zubirán National Institute of Health Sciences and Nutrition
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Dooley, Mary AnneUniversity of North Carolina
(author)
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Peschken, ChristineUniversity of Manitoba
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Isenberg, David
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Rahman, AnisurUniversity College London
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Manzi, SusanAllegheny Health Network
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Jacobsen, SørenCopenhagen University Hospital
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Lim, SamEmory University
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van Vollenhoven, Ronald F.
(author)
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Nived, OlaLund University,Lunds universitet,Reumatologi och molekylär skelettbiologi,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Rheumatology,Section III,Department of Clinical Sciences, Lund,Faculty of Medicine(Swepub:lu)reum-oni
(author)
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Jönsen, AndreasLund University,Lunds universitet,Reumatologi och molekylär skelettbiologi,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Lund SLE Research Group,Forskargrupper vid Lunds universitet,Rheumatology,Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University Research Groups(Swepub:lu)reum-ajo
(author)
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Kamen, Diane L.Medical University of South Carolina
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Aranow, Cynthia
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Sanchez-Guerrero, JorgeToronto Western Hospital
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Gladman, Dafna D.University of Toronto
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Fortin, Paul R.Laval University
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Alarcón, Graciela S.University of Alabama
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Merrill, Joan T.Oklahoma Medical Research Foundation
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Kalunian, KennethUniversity of California, San Diego
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Ramos-Casals, ManuelUniversity of Barcelona
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Steinsson, KristjánNational University Hospital of Iceland
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Zoma, AsadHairmyres Hospital
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Askanase, AncaColumbia University
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Khamashta, Munther A.St Thomas' Hospital
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Bruce, Ian N.University of Manchester
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Inanc, MuratIstanbul University
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Abrahamowicz, MichalMcGill University
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Bernatsky, SashaMcGill University Health Center
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McGill University Health CenterDalhousie University
(creator_code:org_t)
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In:Annals of the Rheumatic Diseases: BMJ81:3, s. 370-3781468-20600003-4967
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Almeida-Brasil, ...
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Hanly, John G.
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Urowitz, Murray
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Clarke, Ann Elai ...
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Ruiz-Irastorza, ...
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Gordon, Caroline
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Ramsey-Goldman, ...
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Petri, Michelle
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Ginzler, Ellen M ...
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Dooley, Mary Ann ...
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Peschken, Christ ...
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Isenberg, David
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Rahman, Anisur
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Manzi, Susan
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Jacobsen, Søren
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Lim, Sam
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van Vollenhoven, ...
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Nived, Ola
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Jönsen, Andreas
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Kamen, Diane L.
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Aranow, Cynthia
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Fortin, Paul R.
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Merrill, Joan T.
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Kalunian, Kennet ...
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