Abstract
801 Factors associated with SLE flares after HCQ taper, discontinuation or maintenance in the SLICC inception cohort: lower education linked with higher flare risk
Lupus science & medicine, v 8(Suppl 2), pp A24-A25
04 Nov 2021
Abstract
BackgroundHydroxychloroquine (HCQ) is a cornerstone treatment of systemic lupus erythematosus (SLE). We compared time to flare in SLE patients discontinuing/reducing HCQ versus those maintaining their dose, and identified factors associated with time to flare.MethodsWe analyzed prospective data from the Systemic Lupus International Collaborating Clinics (SLICC) cohort, which includes SLE patients from 33 sites in Europe, Asia, and North America, enrolled within 15 months of diagnosis and followed annually (1999-2019). We identified patients with HCQ reduction/discontinuation, regardless of disease activity. We evaluated person-time that patients contributed on their initial dose (‘maintenance’), comparing this to person-time contributed after a first dose reduction, and person-time after a first HCQ discontinuation. We estimated time to first flare, defined as either subsequent need for therapy augmentation (steroids or other immunomodulators), increase of ≥4 points in the SLE Disease Activity Index-2000 (SLEDAI-2K) or hospitalization for SLE. We estimated crude flare rates for each sub-cohort and hazard ratios and 95% confidence intervals (CIs) for various demographic and clinical factors potentially associated with flare risk in the reduction and discontinuation sub-cohorts, as well as comparator maintenance sub-cohorts (matched for time on HCQ to the reduction and discontinuation sub-cohorts).ResultsWe studied 1460 SLE patients (90% women, 52% Caucasian) on HCQ. Of these, 592 subsequently reduced HCQ at any point, while 407 discontinued HCQ at any point. The crude flare rate for the HCQ reduction sub-cohort was 42.3 per 100 person-years (95% CI 38.6, 46.4), versus 35.6 (95% CI 32.4, 39.1) in the matched maintenance sub-cohort. In the discontinuation sub-cohort, the crude flare rate was 43.1 (95% CI 38.3, 48.4), versus 34.2 (95% CI 30.6, 38.2) in the matched maintenance sub-cohort. Table 1 shows the factors associated with time to flare within each sub-cohort. The hazard ratios are adjusted by all variables in the table. Prednisone or immunosuppressive use at time-zero was associated with higher flare risk in all analyses. Lower education was associated with higher risk of SLE flares among patients who discontinued HCQ. There was a trend across sub-cohorts for lower flare risk among patients from Asia, versus North America.Abstract 801 Table 1Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for SLE flare across sub-cohorts Characteristics at time zero Sub-cohort I, HCQ reduced Maintenance (matched to I) Sub-cohort II, HCQ discontinued Maintenance (matched to II) aHR (95% CI ) aHR (95% CI ) aHR (95% CI ) aHR (95% CI ) Male sex 1.04 (0.74, 1.45) 0.93 (0.68, 1.29) 0.94 (0.62, 1.42) 0.88 (0.61, 1.27) Non-Caucasian race/ethnicity 1.19 (0.94, 1.51) 1.01 (0.81, 1.26) 0.95 (0.69, 1.29) 1.18 (0.91, 1.54) Age at SLE diagnosis, years 1.00 (0.99, 1.01) 1.00 (0.99, 1.01) 0.99 (0.98, 1.00) 1.01 (1.00, 1.02) No post-secondary education 1.04 (0.85, 1.28) 1.16 (0.95, 1.43) 1.40 (1.07 , 1.83) 0.90 (0.70, 1.15) Geographic location North America Reference Reference Reference Reference Europe 1.16 (0.91, 1.48) 1.10 (0.87, 1.40) 1.03 (0.76, 1.39) 1.05 (0.80, 1.37) Asia 0.69 (0.51 , 0.93) 0.87 (0.61, 1.23) 0.68 (0.46, 1.02) 0.66 (0.43 , 0.99) SLE duration 1.02 (0.98, 1.06) 1.00 (0.96, 1.04) 0.99 (0.95, 1.04) 0.99 (0.95, 1.03) SLEDAI-2K ≥ 4 1.15 (0.94, 1.41) 1.17 (0.94, 1.44) 1.18 (0.90, 1.54) 1.17 (0.92, 1.48) Renal damage 0.90 (0.60, 1.37) 0.99 (0.62, 1.59) 0.81 (0.55, 1.21) 0.82 (0.48, 1.39) Body mass index 1.02 (1.00, 1.04) 1.00 (0.98, 1.01) 0.99 (0.97, 1.02) 0.99 (0.97, 1.01) Smoker 1.07 (0.85, 1.35) 0.98 (0.78, 1.22) 0.95 (0.72, 1.25) 1.09 (0.83, 1.43) Prednisone 1.63 (1.28 , 2.09) 2.03 (1.59 , 2.59) 1.79 (1.31 , 2.44) 2.39 (1.79 , 3.19) Immunosuppressive 1.60 (1.28 , 2.00) 2.34 (1.87 , 2.92) 1.48 (1.09 , 2.01) 2.42 (1.86 , 3.16) Biologics 0.67 (0.36, 1.24) 0.88 (0.47, 1.67) 0.63 (0.32, 1.26) 0.94 (0.45, 1.98) ConclusionsCompared to HCQ maintenance, crude flare rates were numerically higher after HCQ taper/discontinuation. SLE patients on prednisone or immunosuppressives were at higher risk for flare in all groups. The association between lower education and higher SLE flare risk was most clearly seen upon discontinuation of HCQ, suggesting this as a particularly vulnerable group.AcknowledgementsThis research was supported by the Canadian Institutes of Health Research (CIHR).
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- Title
- 801 Factors associated with SLE flares after HCQ taper, discontinuation or maintenance in the SLICC inception cohort: lower education linked with higher flare risk
- Creators
- Celline C Almeida-Brasil - McGill University Health CentreJohn G Hanly - Queen Elizabeth II Health Sciences CentreMurray B Urowitz - University of TorontoAnn E Clarke - University of CalgaryRosalind Ramsey-Goldman - Northwestern UniversityCaroline Gordon - University of BirminghamMichelle A Petri - Johns Hopkins MedicineEllen M Ginzler - SUNY Downstate Health Sciences UniversityDaniel J Wallace - Cedars-Sinai Medical CenterSang-Cheol Bae - Hanyang University Seoul HospitalJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMary Anne Dooley - Kidney AssociatesChristine A Peschken - University of ManitobaDavid A Isenberg - University College LondonAnisur Rahman - University College LondonSusan Manzi - Allegheny Health NetworkSoren Jacobsen - RigshospitaletSam Lim - Emory UniversityRonald van Vollenhoven - University of AmsterdamOla Nived - Lund UniversityAndreas Jonsen - Lund UniversityDiane L Kamen - Medical University of South CarolinaCynthia Aranow - Feinstein Institute for Medical ResearchGuillermo Ruiz-Irastorza - Hospital de CrucesJorge Sanchez-Guerrero - University of TorontoDafna D Gladman - University of TorontoPaul R Fortin - Université LavalGraciela S Alarcón - University of Alabama at BirminghamJoan T Merrill - Oklahoma Medical Research FoundationKenneth C Kalunian - University of California, San DiegoManuel Ramos-Casals - Universitat de BarcelonaKristjan Steinsson - National University Hospital of IcelandAsad Zoma - Hairmyres HospitalAnca Askanase - Columbia University Irving Medical CenterMunther A Khamashta - St Thomas' HospitalIan Bruce - University of ManchesterMurat Inanc - Istanbul UniversitySasha Bernatsky - McGill University Health Centre
- Publication Details
- Lupus science & medicine, v 8(Suppl 2), pp A24-A25
- Publisher
- Lupus Foundation of America
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- General Internal Medicine
- Other Identifier
- 991021933902704721