Journal
JOURNAL OF RHEUMATOLOGY
Volume 40, Issue 6, Pages 831-841Publisher
J RHEUMATOL PUBL CO
DOI: 10.3899/jrheum.120572
Keywords
SYSTEMIC LUPUS ERYTHEMATOSUS; OUTCOMES RESEARCH; DISEASE ACTIVITY; HYDROXYCHLOROQUINE; DAMAGE
Categories
Funding
- Arthritis Society
- Arthritis Centre of Excellence, University of Toronto
- Department of Medicine
- Centre de recherche du centre hospitalier universitaire de Quebec, Universite Laval
- Lupus Canada
- Lupus Ontario
- Lupus Foundation of Ontario
- BC Lupus
- Toronto General and Western Hospital Foundation
- Bristol-Myers Squibb Canada Inc
- Smythe Foundation
- Dance for the Cure
- Flare for Fashion
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Objective. To assess whether hydroxychloroquine (HCQ) prevents early damage in patients with systemic lupus erythematosus (SLE). Methods. We updated an existing systematic review of literature on clinical effects of HCQ in patients with SLE. We conducted a nested case-control study embedded in an inception cohort of patients with SLE. Systemic Lupus International Collaborating Clinics Damage Index (SDI) at 3 years was considered as our primary outcome. Patients with SDI > 0 at 3 years were considered cases and patients with SDI = 0 were controls. Cases and controls were first compared by univariate analysis. Then conditional logistic regression models adjusting for potential confounders were done to study the effect of HCQ on damage accrual. Results. Included in the analysis were 481 patients who had 3 or more years of followup. Out of this cohort, we could match 151 cases with 151 controls. Univariate analysis identified age, the use of any immunosuppressive drugs, HCQ, and cumulative dose of steroids as significant covariates associated with damage accrual. In multivariate analysis, the use of HCQ remained significantly associated with less damage (OR 0.34, 95% CI 0.132-0.867), while age (OR 1.05, 95% CI 1.027-1.078) and a variable combining SLE activity and steroid dose (OR 1.73, 95% CI 1.306-2.295) were associated with damage at 3 years. Conclusion. We demonstrated that HCQ use was associated with less damage at 3 years after diagnosis of SLE when attention was given and adjustment done for disease activity and steroid dose, duration of disease, and calendar year of diagnosis.
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