Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (LUMINA L)
Graciela S. Alarcón,Gerald McGwin,Ana M. Bertoli,Barri J. Fessler,Jaime Calvo-Alén,Holly M. Bastian,Luis M. Vilá,John D. Reveille +7 more
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TLDR
Hydxychloroquine, which overall is well tolerated by patients with SLE, has a protective effect on survival which is evident even after taking into consideration the factors associated with treatment decisions.Abstract:
Objective: In patients with systemic lupus erythematosus (SLE), hydroxychloroquine prevents disease flares and damage accrual and facilitates the response to mycophenolate mofetil in those with renal involvement. A study was undertaken to determine whether hydroxychloroquine also exerts a protective effect on survival. Methods: Patients with SLE from the multiethnic LUMINA (LUpus in MInorities: NAture vs nurture) cohort were studied. A case-control study was performed within the context of this cohort in which deceased patients (cases) were matched for disease duration (within 6 months) with alive patients (controls) in a proportion of 3:1. Survival was the outcome of interest. Propensity scores were derived by logistic regression to adjust for confounding by indication as patients with SLE with milder disease manifestations are more likely to be prescribed hydroxychloroquine. A conditional logistic regression model was used to estimate the risk of death and hydroxychloroquine use with and without the propensity score as the adjustment variable. Results: There were 608 patients, of whom 61 had died (cases). Hydroxychloroquine had a protective effect on survival (OR 0.128 (95% CI 0.054 to 0.301 for hydroxychloroquine alone and OR 0.319 (95% CI 0.118 to 0.864) after adding the propensity score). As expected, the propensity score itself was also protective. Conclusions: Hydroxychloroquine, which overall is well tolerated by patients with SLE, has a protective effect on survival which is evident even after taking into consideration the factors associated with treatment decisions. This information is of importance to all clinicians involved in the care of patients with SLE.read more
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Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review
TL;DR: High levels of evidence were found that AMs prevent lupus flares and increase long-term survival of patients with SLE; moderate evidence of protection against irreversible organ damage, thrombosis and bone mass loss and evidence supporting an effect on severe l upus activity, lipid levels and subclinical atherosclerosis was weak.
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Systemic lupus erythematosus.
Arvind Kaul,Caroline Gordon,Mary K. Crow,Zahi Touma,Murray B. Urowitz,Ronald F van Vollenhoven,Guillermo Ruiz-Irastorza,Graham R. V. Hughes +7 more
TL;DR: The 10-year mortality has improved and toxic adverse effects of older medications such as cyclophosphamide and glucocorticoids have been partially offset by newer drugs such as mycophenolate mofetil and glucose-sparing regimes.
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Epidemiology of CVD in rheumatic disease, with a focus on RA and SLE.
TL;DR: Until additional research and disease-specific risk prediction tools are available, current evidence supports aggressive treatment of disease activity, and careful screening for and management of TRFs.
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Maternal Use of Hydroxychloroquine Is Associated With a Reduced Risk of Recurrent Anti-SSA/Ro-Antibody–Associated Cardiac Manifestations of Neonatal Lupus
Peter M. Izmirly,Nathalie Costedoat-Chalumeau,Cecilia N. Pisoni,Munther A. Khamashta,Mimi Y. Kim,Amit Saxena,Deborah I. Friedman,Carolina Llanos,J.C. Piette,Jill P. Buyon +9 more
TL;DR: Aggregate data from a multinational effort show that in mothers at high risk of having a child with cardiac-NL, the use of HCQ may protect against recurrence of disease in a subsequent pregnancy.
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Systemic lupus erythematosus: Diagnosis and clinical management.
Andrea Fava,Michelle Petri +1 more
TL;DR: The diagnostic approach as well as the etiopathogenetic rationale and clinical evidence for the management of SLE are reviewed, which includes lifestyle changes such as avoidance of ultraviolet light; prevention of comorbidities including coronary artery disease, osteoporosis, infections, and drug toxicities; use of immunomodulators and targeted therapy.
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Journal Article
The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index for Systemic Lupus Erythematosus International Comparison.
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