Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Issue 3 (15th December 2021)

• Record Type: Journal Article
• Authors: Almeida-Brasil, Celline C; Hanly, John G; Urowitz, Murray; Clarke, Ann Elaine; Ruiz-Irastorza, Guillermo; Gordon, Caroline; Ramsey-Goldman, Rosalind; Petri, Michelle; Ginzler, Ellen M; Wallace, D J; Bae, Sang-Cheol; Romero-Diaz, Juanita; Dooley, Mary Anne; Peschken, Christine; Isenberg, David; Rahman, Anisur; Manzi, Susan; Jacobsen, Søren; Lim, Sam; van Vollenhoven, Ronald F; Nived, Ola; Jönsen, Andreas; Kamen, Diane L; Aranow, Cynthia; Sanchez-Guerrero, Jorge; Gladman, Dafna D; Fortin, Paul R; Alarcón, Graciela S; Merrill, Joan T; Kalunian, Kenneth; Ramos-Casals, Manuel; Steinsson, Kristján; Zoma, Asad; Askanase, Anca; Khamashta, Munther A; Bruce, Ian N; Inanc, Murat; Abrahamowicz, Michal; Bernatsky, Sasha;
• Is Part Of: Annals of the rheumatic diseases. Volume 81:Issue 3(2022)
• Page Start: 370
• Page End: 378
• Publication Date: 2021-12-15
• Subjects: systemic lupus erythematosus -- hydroxychloroquine -- autoimmune diseases -- epidemiology; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2021-221295
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : 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.