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Pearl Toh, 2 days ago
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Long-term hydroxychloroquine treatment improves survival in lupus patients

Jairia Dela Cruz
31 Jul 2018

Patients with systemic lupus erythematosus (SLE) on hydroxychloroquine (HCQ) fare better, having lower mortality rates compared with those not using the drug, a study has shown. This survival benefit is further enhanced by treatment adherence.

The study included 2,287 SLE patients treated with HCQ (mean age at diagnosis 35.7 years; 88.4 percent female) and 2,287 propensity-score matched non-HCQ controls from the Taiwan National Health Insurance Research Database (NHIRD). Of these, 169 and 248 died, respectively, during a mean follow-up of 7.6 years.

Specifically, HCQ reduced the risk of death by about 30 percent (hazard ratio [HR], 0.68; 95 percent CI, 0.56–0.82). This survival benefit improved with increased adherence to treatment, such that relative to nonusers, patients with HCQ medication possession ratio (MPR) of 80 percent showed the lowest mortality risk (HR, 0.60), followed by those with 40 percent MPR <80 percent (HR, 0.72) or MPR <40 percent (HR, 0.79). [Rheumatology 2018;doi:10.1093/rheumatology/key167]

With respect to secondary outcomes, HCQ use likewise led to significantly better results. Compared to nonuse, annual prednisolone-equivalent glucocorticoid dose was lower (regression coefficient, –0.22; p=0.008), annual admissions due to SLE were fewer (rate ratio [RR], 0.90; p<0.001), and annual number of emergency room visits was smaller (RR, 0.94; p=0.006).

HCQ has been shown to reduce SLE activity, and treatment maintenance could protect patients with quiescent SLE against a clinical flare-up. According to the authors, the findings imply that the survival improvement may have resulted from decreased disease activity in patients treated with HCQ.

“To our knowledge, only a few studies have examined the association between survival and HCQ among patients with SLE, and this is the only one in Asia,” they said.

However, the study was not able to directly assess SLE activity using a common index such as the SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) or the BILAG (British Isles Lupus Assessment Group) criteria, as linking the NHIRD to individual laboratory results of patients was forbidden for privacy reasons.

Nevertheless, the authors recommended persistent use of HCQ for all SLE patients, owing to the benefits of the drug. Treatment adherence should be actively improved via interventions such as providing education to raise awareness and organizing care with a nurse manager.

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Most Read Articles
Pearl Toh, 2 days ago
A latest study at ISC 2019 shows that even patients with large-core stroke damage can have a good outcome after mechanical clot removal with endovascular thrombectomy (EVT), depending on the size of the infarct and time lapses between stroke onset and treatment.
26 Dec 2017
Supplementation with omega-3 fatty acids in combination with rosuvastatin may yield significant reductions in triglycerides and nonhigh-density lipoprotein (HDL) cholesterol as compared with rosuvastatin monotherapy, according to data from the ROMANTIC (rosuvastatin-omacor in residual hypertriglyceridemia) trial.
24 Aug 2016

Roshini Claire Anthony spoke with Adjunct Associate Professor Gamaliel Tan, head and senior orthopaedic consultant at Ng Teng Fong Hospital in Singapore, on how GPs can help diagnose and treat lower back pain.

Rachel Soon, 12 Dec 2018

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