Journal article
Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
Annals of the rheumatic diseases, v 81(3), pp 370-378
01 Mar 2022
PMID: 34911705
Abstract
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.
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Details
- Title
- Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
- Creators
- Celline C. Almeida-Brasil - McGill University Health CentreJohn G. Hanly - Queen Elizabeth II Health Sciences CentreMurray Urowitz - Toronto Western HospitalAnn Elaine Clarke - University of CalgaryGuillermo Ruiz-Irastorza - Hospital de CrucesCaroline Gordon - University of BirminghamRosalind Ramsey-Goldman - Northwestern UniversityMichelle Petri - Johns Hopkins UniversityEllen M. Ginzler - SUNY Downstate Health Sciences UniversityD. J. Wallace - Cedars-Sinai Medical CenterSang-Cheol Bae - Hanyang UniversityJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMary Anne Dooley - University of North Carolina at Chapel HillChristine Peschken - University of ManitobaDavid Isenberg - University College LondonAnisur Rahman - University College LondonSusan Manzi - Allegheny Health NetworkSoren Jacobsen - Rigshosp, Copenhagen Lupus & Vasculitis Clin, Ctr Rheumatol & Spine Dis, Copenhagen, DenmarkSam Lim - Emory UniversityRonald F. van Vollenhoven - Amsterdam Rheumatol & Immunol Ctr, Dept Rheumatol, Amsterdam, NetherlandsOla Nived - Lund UniversityAndreas Jonsen - Lund UniversityDiane L. Kamen - Medical University of South CarolinaCynthia Aranow - Feinstein Institute for Medical ResearchJorge Sanchez-Guerrero - Toronto Western HospitalDafna D. Gladman - University of TorontoPaul R. Fortin - Université LavalGraciela S. Alarcon - University of Alabama at BirminghamJoan T. Merrill - Oklahoma Medical Research FoundationKenneth 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 N. Bruce - MRC Epidemiology UnitMurat Inanc - Istanbul UniversityMichal Abrahamowicz - McGill UniversitySasha Bernatsky - McGill University Health Centre
- Publication Details
- Annals of the rheumatic diseases, v 81(3), pp 370-378
- Publisher
- Bmj Publishing Group
- Number of pages
- 9
- Grant note
- National Institute for Health Research University College London Hospitals Biomedical Research Center Research Institute of the McGill University Health Centre (RI-MUHC) Sandwell U01DP005119 / Centers for Disease Control and Prevention; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA NIHR Manchester Biomedical Centre AR43727; AR69572; 5UL1TR001422-02; UL-1RR-025741; K24-AR-02318; P60AR064464; RR00046 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA NRF-2017M3A9B4050335 / Bio & Medical Technology Development Programme of the National Research Foundation of the Republic of Korea NIHR/Wellcome Trust Manchester Clinical Research Facility CIHR Drug Safety and Effectiveness Cross-Disciplinary Training ProgramProgramme (DSECT); Canadian Institutes of Health Research (CIHR) A3865 / Danish Rheumatism Association
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000759747800028
- Scopus ID
- 2-s2.0-85124635089
- Other Identifier
- 991021933900404721