Hydroxychloroquine protects against lupus flares during pregnancy, after delivery
In women, the incidence of lupus flares appears to be high during pregnancy and within 3 months postpartum, a study reports. However, this flare risk can be mitigated by hydroxychloroquine (HCQ) treatment.
Researchers drew data from the 1987–2015 Hopkins Lupus Cohort and examined 1,349 women aged 14–45 years with >1 measurement of disease activity. There were 398 pregnancies reported in 304 women.
The main outcome was disease flare, which was defined as (1) change in Physician Global Assessment (PGA) ≥1 from previous visit and (2) change in Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) ≥4 from previous visit. Time-varying exposures were classified as pregnancy, postpartum or nonpregnant/nonpostpartum periods.
Results showed an increased rate of flare defined by PGA during pregnancy (hazard ratio [HR], 1.59; 95 percent CI, 1.27–1.96), but this effect was modified by HCQ use. The risk of flare during pregnancy relative to nonpregnant/nonpostpartum periods was increased by 1.26 times (0.88–1.69) among HCQ users and by 1.83 (1.34–2.45) among non-HCQ users.
The risk of flare was likewise elevated among non-HCQ users in the 3 months postpartum, but not among women taking HCQ after delivery.
Findings of the present study support prior data suggesting HCQ may prevent lupus flares during pregnancy and contribute evidence on the protective effect of the drug against postpartum flares, researchers said.
Taken together, the data provide reassurance to many women with lupus that they do not need to expect a lupus flare during or after pregnancy, particularly if they continue HCQ therapy, researchers added.