Journal ArticleDOI
Systemic lupus erythematosus in three ethnic groups: XVI. Association of hydroxychloroquine use with reduced risk of damage accrual.
Barri J. Fessler,Graciela S. Alarcón,Gerald McGwin,Jeffrey M. Roseman,Holly M. Bastian,Alan Friedman,Bruce A. Baethge,Luis M. Vilá,John D. Reveille +8 more
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TLDR
Findings indicate that, after adjustment for propensity to receive HCQ, HCQ usage is independently associated with a reduced risk of damage accrual in SLE patients who had not yet accrued damage at the time of treatment initiation.Abstract:
Objective
To examine whether hydroxychloroquine (HCQ) usage is associated with a reduced risk of damage accrual in patients with systemic lupus erythematosus (SLE).
Methods
Patients (n = 518) meeting the American College of Rheumatology criteria for diagnosis of SLE and with ≤5 years disease duration at study entry were followed up annually. Socioeconomic, demographic, clinical, and serologic manifestations as well as disease activity (by the Systemic Lupus Activity Measure [SLAM]) and damage (by the Systemic Lupus International Collaborating Clinics damage index [SDI]) were measured. Propensity scores were calculated to adjust for confounding factors affecting treatment assignment. A Cox proportional hazards model was used to compare the risk of developing new damage according to HCQ use at enrollment into the study.
Results
Fifty-six percent of the patients were treated with HCQ at the time of study enrollment. Patients who were not treated with HCQ on enrollment had higher SLAM and SDI scores than patients who were treated. Untreated patients were significantly more likely to have major organ involvement such as renal disease (P < 0.0001) or central nervous system disease (P < 0.0025). Results of unadjusted analysis suggested that treated patients were less likely to accrue damage (hazard ratio [HR] 0.68). With adjustment for differences in treatment assignment, HCQ usage was still associated with a reduced risk of developing new damage, with an HR of 0.68 (95% confidence interval [95% CI] 0.53–0.93) (P = 0.014). With adjustment for differences in treatment assignment, HCQ usage was still associated with a reduced risk of developing new damage (HR 0.73 [95% CI 0.52–1.00]) (P = 0.05). However, patients receiving HCQ who had no damage at study entry had a statistically significant decrease in the risk of damage accrual (HR 0.55 [95% CI 0.34–0.87]) (P = 0.0111), whereas those receiving HCQ who had damage at study entry did not (HR 1.106 [95% CI 0.70–1.74]) (P = 0.6630).
Conclusion
These findings indicate that, after adjustment for propensity to receive HCQ, HCQ usage is independently associated with a reduced risk of damage accrual in SLE patients who had not yet accrued damage at the time of treatment initiation.read more
Citations
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American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis
Bevra H. Hahn,Maureen McMahon,Alan H. Wilkinson,W. Dean Wallace,David I. Daikh,John FitzGerald,George Karpouzas,Joan T. Merrill,Daniel J. Wallace,Jinoos Yazdany,Rosalind Ramsey-Goldman,Karandeep Singh,Mazdak A. Khalighi,Soo I. Choi,Maneesh Gogia,Suzanne Kafaja,Mohammad Kamgar,Christine Lau,William J. Martin,Sefali Parikh,Justin Peng,Anjay Rastogi,Weiling Chen,Jennifer M. Grossman +23 more
TL;DR: The management strategies discussed here apply to lupus nephritis in adults, particularly to those receiving care in the United States of America, and include interventions that were available in theUnited States as of April 2011.
Journal ArticleDOI
Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis
George Bertsias,Maria G Tektonidou,Zahir Amoura,Martin Aringer,Ingeborg M. Bajema,Jo H. M. Berden,John Boletis,Ricard Cervera,Thomas Dörner,Andrea Doria,Franco Ferrario,Jürgen Floege,Frédéric Houssiau,John P. A. Ioannidis,David A. Isenberg,Cees G. M. Kallenberg,Liz Lightstone,Stephen D. Marks,Alberto Martini,G. Moroni,Irmgard Neumann,Manuel Praga,Matthias Schneider,Argyre Starra,Vladimir Tesar,Carlos Vasconcelos,Ronald F van Vollenhoven,Helena Zakharova,Marion Haubitz,Caroline Gordon,David Jayne,Dimitrios T. Boumpas +31 more
TL;DR: Recommendations for the management of lupus nephritis were developed using an evidence-based approach followed by expert consensus and there is no evidence to suggest that management of LN should differ in children versus adults.
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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.
Journal ArticleDOI
Treat-to-target in systemic lupus erythematosus: recommendations from an international task force
Ronald F. van Vollenhoven,Marta Mosca,George Bertsias,David A. Isenberg,Annegret Kuhn,Kristen Lerstrom,Martin Aringer,Hendrika Bootsma,Dimitrios T. Boumpas,Ian N. Bruce,Ricard Cervera,Ann E. Clarke,Nathalie Costedoat-Chalumeau,László Czirják,Ronald H. W. M. Derksen,Thomas Dörner,Caroline Gordon,Winfried Graninger,Frédéric Houssiau,Murat Inanc,Søren Jacobsen,David Jayne,A. Jedryka-Goral,A. Levitsky,Roger A. Levy,Xavier Mariette,Eric F Morand,Sandra V. Navarra,Irmgard Neumann,Anisur Rahman,Jozef Rovensky,Josef S Smolen,Carlos Vasconcelos,Alexandre E. Voskuyl,Anne Voss,Helena Zakharova,Asad Zoma,Matthias Schneider +37 more
TL;DR: Treating-to-target-in-SLE (T2T/SLE) recommendations were developed by a large task force of multispecialty experts and a patient representative and it is anticipated that ‘treating- to-target’ can and will be applicable to the care of patients with SLE.
Journal ArticleDOI
KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases
Brad H. Rovin,Sharon G. Adler,Jonathan Barratt,Frank Bridoux,Kelly A. Burdge,Tak Mao Chan,H. Terence Cook,Fernando C. Fervenza,Keisha L. Gibson,Richard J. Glassock,David Jayne,Vivekanand Jha,Adrian Liew,Zhihong Liu,Juan M. Mejia-Vilet,Carla M. Nester,Jai Radhakrishnan,Elizabeth M. Rave,Heather N. Reich,Pierre Ronco,Jan-Stephan F. Sanders,Sanjeev Sethi,Yusuke Suzuki,Sydney C.W. Tang,Vladimir Tesar,Marina Vivarelli,Jack F.M. Wetzels,Jürgen Floege +27 more
References
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Journal ArticleDOI
The 1982 revised criteria for the classification of systemic lupus erythematosus
Eng M. Tan,Alan S. Cohen,James F. Fries,Alfonse T. Masi,Dennis J. McShane,Naomi F. Rothfield,Jane G. Schaller,Norman Talal,Robert Winchester +8 more
TL;DR: The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunologic knowledge and improve disease classification and showed gains in sensitivity and specificity.
Journal ArticleDOI
Propensity score methods for bias reduction in the comparison of a treatment to a non‐randomized control group
TL;DR: The propensity score, defined as the conditional probability of being treated given the covariates, can be used to balance the variance of covariates in the two groups, and therefore reduce bias as mentioned in this paper.
Journal ArticleDOI
Estimating Causal Effects from Large Data Sets Using Propensity Scores
TL;DR: Propensity score methods generalize subclassification in the presence of many confounding covariates, such as age, region of the country, and sex, in a study of smoking and mortality.
Journal ArticleDOI
The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus.
Dafna D. Gladman,Ellen M. Ginzler,Charles H. Goldsmith,Paul R. Fortin,Matthew H. Liang,MB Urowitz,Paul A. Bacon,Stefano Bombardieri,John G. Hanly,Elaine M Hay,David A. Isenberg,Jones Jv,Kenneth C. Kalunian,Peter J. Maddison,Ola Nived,Michelle Petri,Martin Richter,Jorge Sanchez-Guerrero,M L Snaith,Gunnar Sturfelt,Deborah P M Symmons,Asad Zoma +21 more
TL;DR: This damage index for SLE records damage occurring in patients with SLE regardless of its cause and was demonstrated to have content, face, criterion, and discriminant validity.
Journal ArticleDOI
Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients
Ricard Cervera,Munther A. Khamashta,Josep Font,Gian Domenico Sebastiani,Antonio Gil,Lavilla P,Juan Carlos Mejía,A. Olcay Aydintug,Hanna Chwalinska-Sadowska,Enrique de Ramón,Antonio Fernández-Nebro,Mauro Galeazzi,Merete Valen,Alessandro Mathieu,Frédéric Houssiau,Natividad Caro,Paula Alba,Manuel Ramos-Casals,Miguel Ingelmo,Graham R. V. Hughes +19 more
TL;DR: In this paper, the authors assessed the frequency and characteristics of the main causes of morbidity and mortality in systemic lupus erythematosus (SLE) during a 10-year period and compared the frequency of early manifestations with those that appeared later in the evolution of the disease.
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