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Flares after hydrox...
Flares after hydroxychloroquine reduction or discontinuation : results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
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- Almeida-Brasil, Celline C. (author)
- McGill University Health Center
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- Hanly, John G. (author)
- Dalhousie University
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- Urowitz, Murray (author)
- University of Toronto
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- Clarke, Ann Elaine (author)
- University of Calgary
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- Ruiz-Irastorza, Guillermo (author)
- Hospital de Cruces
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- Gordon, Caroline (author)
- University of Birmingham
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- Ramsey-Goldman, Rosalind (author)
- Northwestern University
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- Petri, Michelle (author)
- Johns Hopkins University
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- Ginzler, Ellen M. (author)
- SUNY Downstate Health Sciences University
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- Wallace, D. J. (author)
- University of California, Los Angeles
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- Bae, Sang Cheol (author)
- Hanyang University
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- Romero-Diaz, Juanita (author)
- Salvador Zubirán National Institute of Health Sciences and Nutrition
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- Dooley, Mary Anne (author)
- University of North Carolina
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- Peschken, Christine (author)
- University of Manitoba
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Isenberg, David (author)
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- Rahman, Anisur (author)
- University College London
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- Manzi, Susan (author)
- Allegheny Health Network
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- Jacobsen, Søren (author)
- Copenhagen University Hospital
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- Lim, Sam (author)
- Emory University
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van Vollenhoven, Ronald F. (author)
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- Nived, Ola (author)
- Lund 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
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- Jönsen, Andreas (author)
- Lund 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
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- Kamen, Diane L. (author)
- Medical University of South Carolina
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Aranow, Cynthia (author)
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- Sanchez-Guerrero, Jorge (author)
- Toronto Western Hospital
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- Gladman, Dafna D. (author)
- University of Toronto
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- Fortin, Paul R. (author)
- Laval University
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- Alarcón, Graciela S. (author)
- University of Alabama
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- Merrill, Joan T. (author)
- Oklahoma Medical Research Foundation
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- Kalunian, Kenneth (author)
- University of California, San Diego
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- Ramos-Casals, Manuel (author)
- University of Barcelona
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- Steinsson, Kristján (author)
- National University Hospital of Iceland
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- Zoma, Asad (author)
- Hairmyres Hospital
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- Askanase, Anca (author)
- Columbia University
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- Khamashta, Munther A. (author)
- St Thomas' Hospital
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- Bruce, Ian N. (author)
- University of Manchester
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- Inanc, Murat (author)
- Istanbul University
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- Abrahamowicz, Michal (author)
- McGill University
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- Bernatsky, Sasha (author)
- McGill University Health Center
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(creator_code:org_t)
- 2021-12-15
- 2022
- English 9 s.
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In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 81:3, s. 370-378
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http://dx.doi.org/10... (free)
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https://ard.bmj.com/...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Subject headings
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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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reumatologi och inflammation (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Rheumatology and Autoimmunity (hsv//eng)
Keyword
- autoimmune diseases
- epidemiology
- hydroxychloroquine
- systemic lupus erythematosus
Publication and Content Type
- art (subject category)
- ref (subject category)
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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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show more...
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Ramsey-Goldman, ...
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Petri, Michelle
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Ginzler, Ellen M ...
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Wallace, D. J.
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Bae, Sang Cheol
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Romero-Diaz, Jua ...
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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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Sanchez-Guerrero ...
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Gladman, Dafna D ...
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Fortin, Paul R.
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Alarcón, Graciel ...
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Merrill, Joan T.
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Kalunian, Kennet ...
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Ramos-Casals, Ma ...
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Steinsson, Krist ...
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Zoma, Asad
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Askanase, Anca
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Khamashta, Munth ...
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Bruce, Ian N.
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Inanc, Murat
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Abrahamowicz, Mi ...
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Bernatsky, Sasha
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