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Antimalarial exposure during pregnancy protects against cardiac neonatal lupus

11 Jul 2017

Exposure to antimalarial drugs throughout pregnancy may lower the likelihood of developing cardiac but not noncardiac neonatal lupus, according to a single-centre retrospective cohort study.

Researchers examined 268 pregnancies in women with a connective tissue disease (CTD) and positive anti-Ro and/or anti-La antibodies. Exposure to antimalarials was defined as hydroxychloroquine (HCQ) or chloroquine throughout pregnancy. Outcomes of interest were cardiac and noncardiac neonatal lupus.

Of the pregnancies, 73 were exposed to antimalarials. Neonatal lupus occurred in 99 children, whereas 117 were unaffected. The remaining 52 children, while not having developed cardiac neonatal lupus, could not be categorized as unaffected as their full noncardiac neonatal lupus status was unknown.

Logistic regression analysis found a protective association between antimalarial exposure and cardiac neonatal lupus, although the result was not statistically significant (odds ratio [OR], 0.21; p=0.07). On Bayesian analysis, the probability of achieving protection (OR <1.0) against cardiac neonatal lupus was significant (98.7 percent). On the other hand, the effect of antimalarials on noncardiac neonatal lupus was not found to be significant (OR, 0.78; p=0.21).

Antimalarials, particularly hydroxychloroquine, have widely recognized benefits beyond the control of disease activity among systemic lupus erythematosus patients. Recent data support the role of prolonged hydroxychloroquine treatment in the prevention of damage accrual, which may extend to increased survival. Furthermore, the drug has been proven to be safe to the foetus during pregnancy and to newborns, as it does not induce retinal toxicity, ototoxicity, adverse effects on infant growth or neurodevelopment. [J Rheumatol 2005;32:1709–1712; Lupus 2004;13:688–689]

Antimalarial drugs, particularly HCQ, have been shown to have immunomodulatory, hypoglycaemic, lipid-lowering and antithrombotic effects. Given the benefits and the safety profile of the drug, a study has recommended prescription of HCQ to all SLE patients, with the drug dosed to the ideal body weight rather than to the actual weight. Timely ophthalmological monitoring should also be performed to prevent retinal toxicity. [Future Rheumatol 2006;1:225–233]

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