دورية أكاديمية
Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
| العنوان: | Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort |
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| المؤلفون: | Almeida-Brasil, CC, Hanly, JG, Urowitz, M, Clarke, AE, Ruiz-Irastorza, G, Gordon, C, Ramsey-Goldman, R, Petri, M, Ginzler, EM, Wallace, DJ, Bae, S-C, Romero-Diaz, J, Dooley, MA, Peschken, C, Isenberg, D, Rahman, A, Manzi, S, Jacobsen, S, Lim, S, van Vollenhoven, RF, Nived, O, Jönsen, A, Kamen, DL, Aranow, C, Sanchez-Guerrero, J, Gladman, DD, Fortin, PR, Alarcón, GS, Merrill, JT, Kalunian, K, Ramos-Casals, M, Steinsson, K, Zoma, A, Askanase, A, Khamashta, MA, Bruce, IN, Inanc, M, Abrahamowicz, M, Bernatsky, S |
| المصدر: | Annals of the Rheumatic Diseases (2021) (In press). |
| سنة النشر: | 2021 |
| المجموعة: | University College London: UCL Discovery |
| مصطلحات موضوعية: | Autoimmune diseases, epidemiology, hydroxychloroquine, systemic lupus erythematosus |
| الوصف: | 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. |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | text |
| اللغة: | English |
| العلاقة: | https://discovery.ucl.ac.uk/id/eprint/10140728/1/annrheumdis-2021-221295.full.pdfTest; https://discovery.ucl.ac.uk/id/eprint/10140728Test/ |
| الإتاحة: | https://discovery.ucl.ac.uk/id/eprint/10140728/1/annrheumdis-2021-221295.full.pdfTest https://discovery.ucl.ac.uk/id/eprint/10140728Test/ |
| حقوق: | open |
| رقم الانضمام: | edsbas.59A33EFB |
| قاعدة البيانات: | BASE |
| الوصف غير متاح. |