Journal article
Association Between Severe Nonadherence to Hydroxychloroquine and Systemic Lupus Erythematosus Flares, Damage, and Mortality in 660 Patients From the SLICC Inception Cohort
Arthritis & rheumatology (Hoboken, N.J.), v 75(12), pp 2195-2206
Dec 2023
PMID: 37459273
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
The goals of this study were to assess the associations of severe nonadherence to hydroxychloroquine (HCQ), objectively assessed by HCQ serum levels, and risks of systemic lupus erythematosus (SLE) flares, damage, and mortality rates over five years of follow-up.
The Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort is an international multicenter initiative (33 centers throughout 11 countries). The serum of patients prescribed HCQ for at least three months at enrollment were analyzed. Severe nonadherence was defined by a serum HCQ level <106 ng/mL or <53 ng/mL for HCQ doses of 400 or 200 mg/day, respectively. Associations with the risk of a flare (defined as a Systemic Lupus Erythematosus Disease Activity Index 2000 increase ≥4 points, initiation of prednisone or immunosuppressive drugs, or new renal involvement) were studied with logistic regression, and associations with damage (first SLICC/American College of Rheumatology Damage Index [SDI] increase ≥1 point) and mortality with separate Cox proportional hazard models.
Of the 1,849 cohort participants, 660 patients (88% women) were included. Median (interquartile range) serum HCQ was 388 ng/mL (244-566); 48 patients (7.3%) had severe HCQ nonadherence. No covariates were clearly associated with severe nonadherence, which was, however, independently associated with both flare (odds ratio 3.38; 95% confidence interval [CI] 1.80-6.42) and an increase in the SDI within each of the first three years (hazard ratio [HR] 1.92 at three years; 95% CI 1.05-3.50). Eleven patients died within five years, including 3 with severe nonadherence (crude HR 5.41; 95% CI 1.43-20.39).
Severe nonadherence was independently associated with the risks of an SLE flare in the following year, early damage, and five-year mortality.
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Details
- Title
- Association Between Severe Nonadherence to Hydroxychloroquine and Systemic Lupus Erythematosus Flares, Damage, and Mortality in 660 Patients From the SLICC Inception Cohort
- Creators
- Yann Nguyen - InsermBenoît Blanchet - Hôpital CochinMurray B Urowitz - Krembil Research InstituteJohn G Hanly - Queen Elizabeth II Health Sciences CentreCaroline Gordon - University of BirminghamSang-Cheol Bae - Hanyang University Seoul HospitalJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránJorge Sanchez-Guerrero - Mount Sinai HospitalAnn E Clarke - University of CalgarySasha Bernatsky - McGill University Health CentreDaniel J Wallace - Cedars-Sinai Medical CenterDavid A Isenberg - University College LondonAnisur Rahman - University College LondonJoan T Merrill - Oklahoma Medical Research FoundationPaul R Fortin - Université LavalDafna D Gladman - Toronto Western HospitalIan N Bruce - Manchester Academic Health Science CentreMichelle Petri - Johns Hopkins MedicineEllen M Ginzler - SUNY Downstate Health Sciences UniversityMary Anne Dooley - University of North Carolina at Chapel HillRosalind Ramsey-Goldman - Northwestern UniversitySusan Manzi - Allegheny Health NetworkAndreas Jönsen - Lund UniversityGraciela S Alarcón - University of Alabama at BirminghamRonald F Van Vollenhoven - University of AmsterdamCynthia Aranow - Feinstein Institute for Medical ResearchVéronique Le Guern - Université Paris CitéMeggan Mackay - Feinstein Institute for Medical ResearchGuillermo Ruiz-Irastorza - BioCruces Health research InstituteS Sam Lim - Emory UniversityMurat Inanc - Istanbul UniversityKenneth C Kalunian - University of California, San DiegoSøren Jacobsen - Copenhagen University HospitalChristine A Peschken - University of ManitobaDiane L Kamen - Medical University of South CarolinaAnca Askanase - New York University Langone Orthopedic HospitalJill Buyon - New York UniversityNathalie Costedoat-Chalumeau - Inserm
- Publication Details
- Arthritis & rheumatology (Hoboken, N.J.), v 75(12), pp 2195-2206
- Publisher
- Wiley
- Grant note
- P30 AR072579 / NIAMS NIH HHS R01 AR043727 / NIAMS NIH HHS M01 RR000046 / NCRR NIH HHS UL1 TR000150 / NCATS NIH HHS Wellcome Trust UL1 TR001422 / NCATS NIH HHS UL1 RR025741 / NCRR NIH HHS Arthritis Research UK P60 AR048098 / NIAMS NIH HHS P60 AR064464 / NIAMS NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:001104841900001
- Scopus ID
- 2-s2.0-85171781248
- Other Identifier
- 991021933897804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology