Association Between Severe Nonadherence to Hydroxychloroquine and Systemic Lupus Erythematosus Flares, Damage, and Mortality in 660 Patients From the SLICC Inception Cohort.
Journal
Arthritis & rheumatology (Hoboken, N.J.)
ISSN: 2326-5205
Titre abrégé: Arthritis Rheumatol
Pays: United States
ID NLM: 101623795
Informations de publication
Date de publication:
12 2023
12 2023
Historique:
revised:
05
06
2023
received:
05
06
2023
accepted:
29
06
2023
pmc-release:
01
12
2024
medline:
30
11
2023
pubmed:
17
7
2023
entrez:
17
7
2023
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 37459273
doi: 10.1002/art.42645
pmc: PMC10792124
mid: NIHMS1915886
doi:
Substances chimiques
Hydroxychloroquine
4QWG6N8QKH
Prednisone
VB0R961HZT
Immunosuppressive Agents
0
Types de publication
Multicenter Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2195-2206Subventions
Organisme : NCRR NIH HHS
ID : M01 RR000046
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000150
Pays : United States
Organisme : NCRR NIH HHS
ID : UL1 RR025741
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001422
Pays : United States
Organisme : NIAMS NIH HHS
ID : P30 AR072579
Pays : United States
Organisme : NIAMS NIH HHS
ID : R01 AR043727
Pays : United States
Organisme : NIH HHS
ID : AR43727 and 69572
Pays : United States
Organisme : Arthritis Research UK
Pays : United Kingdom
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : NIAMS NIH HHS
ID : R01 AR069572
Pays : United States
Organisme : NIAMS NIH HHS
ID : P60 AR064464
Pays : United States
Organisme : NIAMS NIH HHS
ID : P60 AR048098
Pays : United States
Informations de copyright
© 2023 The Authors. Arthritis & Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.
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