Association Between Severe Nonadherence to Hydroxychloroquine and Systemic Lupus Erythematosus Flares, Damage, and Mortality in 660 Patients From the SLICC Inception Cohort

Nguyen, Y; Blanchet, B; Urowitz, MB; Hanly, JG; Gordon, C; Bae, SC; Romero-Diaz, J; Sanchez-Guerrero, J; Clarke, AE; Bernatsky, S; Wallace, DJ; Isenberg, DA; Rahman, A; Merrill, JT; Fortin, PR; Gladman, DD; Bruce, IN; Petri, M; Ginzler, EM; Dooley, MA; Ramsey-Goldman, R; Manzi, S; Jönsen, A; Alarcón, GS; Van Vollenhoven, RF; Aranow, C; Le Guern, V; Mackay, M; Ruiz-Irastorza, G; Lim, SS; Inanc, M; Kalunian, KC; Jacobsen, S; Peschken, CA; Kamen, DL; Askanase, A; Buyon, J; Costedoat-Chalumeau, N

doi:10.1002/art.42645

Lupus & antiphospholipid syndrome

Association Between Severe Nonadherence to Hydroxychloroquine and Systemic Lupus Erythematosus Flares, Damage, and Mortality in 660 Patients From the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort

Arthritis RheumatolPublished 13 Nov 2023Prospective cohort study

Main finding · SLE flareResultOdds ratio 3.38 95% CI 1.80–6.42

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Authors' conclusion

Severe nonadherence was independently associated with the risks of an SLE flare in the following year, early damage, and five-year mortality.

Study context

Population: Patients with systemic lupus erythematosus (SLE) in the SLICC Inception Cohort prescribed hydroxychloroquine (HCQ) for at least three months at enrollment88% women
Participants: 660 patients

Exposure: Severe nonadherence to HCQ vs no severe nonadherence
Severe nonadherencen = 48
Outcome: SLE flare (SLEDAI-2K increase ≥4 points, initiation of prednisone or immunosuppressive drugs, or new renal involvement), damage (first SDI increase ≥1 point) and mortality
Follow-up: Five years

Methodological detailsinternational multicentre (33 centres, 11 countries), inception cohort, logistic regression, Cox proportional hazard models

International multicentre (33 centres, 11 countries)
Inception cohort
Logistic regression
Cox proportional hazard models

Main finding

SLE flare

Odds ratio

3.38

95% CI 1.80–6.42

Severe nonadherencevs No severe nonadherence

OR 3.38 (95% CI 1.80–6.42)

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	Severe nonadherence	← Lower risk with severe nonadherence ←→ Higher risk with severe nonadherence →	Estimate
Damage (SDI increase) · three yearsIndependently associated		0.050.21520	HR 1.92 (95% CI 1.05–3.50)
Mortality · five years	3 events	0.050.21520	crude HR 5.41 (95% CI 1.43–20.39)
		0.050.21520Ratio (log scale)

Mortality — Deaths within five years (all patients): 11

Serum HCQ level (all patients)

Median (IQR) serum HCQ, ng/mL: 388 (244-566)

Reference

Authors: Nguyen Y, Blanchet B, Urowitz MB, Hanly JG, Gordon C, Bae SC, et al.
All 38 authors
Nguyen Y, Blanchet B, Urowitz MB, Hanly JG, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Clarke AE, Bernatsky S, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Ramsey-Goldman R, Manzi S, Jönsen A, Alarcón GS, Van Vollenhoven RF, Aranow C, Le Guern V, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askanase A, Buyon J, Costedoat-Chalumeau N
Journal: Arthritis & Rheumatology
Published: 13 Nov 2023
DOI: 10.1002/art.42645
PubMed: 37459273

Topic: Lupus & antiphospholipid syndrome

Exposure definitions

Severe nonadherence: serum HCQ level <106 ng/mL or <53 ng/mL for HCQ doses of 400 or 200 mg/day, respectively

Key notes

Independently associated

Original publication

Association Between Severe Nonadherence to Hydroxychloroquine and Systemic Lupus Erythematosus Flares, Damage, and Mortality in 660 Patients From the SLICC Inception Cohort. Arthritis Rheumatol. Published 13 November 2023. doi:10.1002/art.42645

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