TY - JOUR
T1 - Flares after hydroxychloroquine reduction or discontinuation
T2 - results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
AU - Almeida-Brasil, Celline C.
AU - Hanly, John G.
AU - Urowitz, Murray
AU - Clarke, Ann Elaine
AU - Ruiz-Irastorza, Guillermo
AU - Gordon, Caroline
AU - Ramsey-Goldman, Rosalind
AU - Petri, Michelle
AU - Ginzler, Ellen M.
AU - Wallace, D. J.
AU - Bae, Sang-Cheol
AU - Romero-Diaz, Juanita
AU - Dooley, Mary Anne
AU - Peschken, Christine
AU - Isenberg, David
AU - Rahman, Anisur
AU - Manzi, Susan
AU - Jacobsen, S. ren
AU - Lim, Sam
AU - van Vollenhoven, Ronald F.
AU - Nived, Ola
AU - Jönsen, Andreas
AU - Kamen, Diane L.
AU - Aranow, Cynthia
AU - Sanchez-Guerrero, Jorge
AU - Gladman, Dafna D.
AU - Fortin, Paul R.
AU - Alarcón, Graciela S.
AU - Merrill, Joan T.
AU - Kalunian, Kenneth
AU - Ramos-Casals, Manuel
AU - Steinsson, Kristján
AU - Zoma, Asad
AU - Askanase, Anca
AU - Khamashta, Munther A.
AU - Bruce, Ian N.
AU - Inanc, Murat
AU - Abrahamowicz, Michal
AU - Bernatsky, Sasha
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - 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.
AB - 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.
KW - autoimmune diseases
KW - epidemiology
KW - hydroxychloroquine
KW - systemic lupus erythematosus
UR - https://www.scopus.com/pages/publications/85124635089
U2 - 10.1136/annrheumdis-2021-221295
DO - 10.1136/annrheumdis-2021-221295
M3 - Article
C2 - 34911705
SN - 0003-4967
VL - 81
SP - 370
EP - 378
JO - Annals of the rheumatic diseases
JF - Annals of the rheumatic diseases
IS - 3
ER -