Abstract
LO-024 Association between severe non-adherence to hydroxychloroquine and SLE flares, damage, and mortality in 660 patients from the SLICC inception cohort
Lupus science & medicine, v 10(Suppl 1), pp A21-A21
01 Jul 2023
Abstract
BackgroundHydroxychloroquine is one of the major treatment of SLE, but its effectiveness is impaired by non-adherence, reported to range from 3% to 85% in SLE patients. Our objective was to assess the associations of severe non-adherence to HCQ, objectively assessed by HCQ serum levels, and risks of SLE flares, damage, and mortality over 5 years of follow-up.MethodsThe SLICC Inception Cohort is a multicenter initiative (33 centers; 11 countries). Serum of patients taking HCQ for at least 3 months, sampled at enrolment or during the first-year follow-up visit, were analyzed. Severe non-adherence was defined by a serum HCQ level <106 ng/ml or <53 ng/ml, for daily HCQ doses of 400 or 200 mg/d, respectively. Association with the risk of a flare (defined as a SLEDAI-2K increase ≥4 points, initiation of prednisone or immunosuppressive drugs, or new renal involvement) was studied with logistic regression, and association with damage (first SLICC/ACR Damage Index (SDI) increase ≥1 point) and mortality were studied with separate Cox proportional hazard models.ResultsOf 1849 cohort subjects, 660 patients (88% women) were included. Median [interquartile range] serum HCQ was 388 ng/ml (244–566); 48 patients (7.3%) had severe HCQ non-adherence. No factors were clearly associated with severe non-adherence. Severe non-adherence was independently associated with flare (OR 3.38; 95% CI 1.80–6.42) and of an increase in the SDI within each of the first 3 years (HR 1.92 at 3 years; 95% CI 1.05–3.50). Eleven patients died within 5 years, including 3 with severe non-adherence (HR 5.41; 95% CI 1.43–20.39).ConclusionsSevere non-adherence was independently associated with the risk of an SLE flare in the following year, with early damage and 5-year mortality. Our results suggest the benefits of testing of detecting severe non-adherence and dedicating more resources and more time to these patients, to improve their long-term prognosis.
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- Title
- LO-024 Association between severe non-adherence to hydroxychloroquine and SLE flares, damage, and mortality in 660 patients from the SLICC inception cohort
- Creators
- Yann Nguyen - Assistance Publique – Hôpitaux de ParisBenoît Blanchet - Hôpital CochinMurray Urowitz - Toronto Western HospitalJohn Hanly - Queen Elizabeth II Health Sciences CentreCaroline Gordon - University of BirminghamSang-Cheol BaeJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránJorge Sanchez-Guerrero - Mount Sinai HospitalAnn Clarke - University of CalgarySasha Bernatsky - McGill University Health CentreDaniel Wallace - Cedars-Sinai Medical CenterDavid Isenberg - University College LondonAnisur Rahman - University College LondonJoan Merrill - Oklahoma Medical Research FoundationPaul tinDafna Gladman - Arthritis SocietyIan Bruce - NIHR Manchester Biomedical Research CentreMichelle Petri - Johns Hopkins MedicineEllen Ginzler - SUNY Downstate Health Sciences UniversityMary Dooley - University of North Carolina at Chapel HillRosalind Ramsey-Goldman - Northwestern UniversitySusan Manzi - Allegheny Health NetworkAndreas Jönsen - Lund UniversityGraciela Alarcón - University of Alabama at BirminghamRonald FVan Vollenhoven - University of AmsterdamCynthia Aranow - Feinstein Institute for Medical ResearchVéronique Le Guern - Université Paris CitéMeggan Mackay - Feinstein Institute for Medical ResearchGuillermo Ruiz-Irastorza - University of the Basque CountrySam Lin - Emory UniversityMurat Inanc - Istanbul UniversityKenneth Kalunian - University of California San DiegoSøren Jacobsen - Copenhagen University HospitalChristine Peschken - University of ManitobaDiane Kamen - Medical University of South CarolinaAnca Askanase - New York University Langone Orthopedic HospitalJill Buyon - New York UniversityNathalie Costedoat-Chalumeau - Université Paris Cité
- Publication Details
- Lupus science & medicine, v 10(Suppl 1), pp A21-A21
- Publisher
- BMJ Publishing Group LTD
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- General Internal Medicine
- Other Identifier
- 991021933902604721