Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort

Celline C. Almeida-Brasil, John G. Hanly, Murray Urowitz, Ann Elaine Clarke, Guillermo Ruiz-Irastorza, Caroline Gordon, Rosalind Ramsey-Goldman, Michelle Petri, Ellen M. Ginzler, D. J. Wallace, Sang Cheol Bae, Juanita Romero-Diaz, Mary Anne Dooley, Christine Peschken, David Isenberg, Anisur Rahman, Susan Manzi, Søren Jacobsen, Sam Lim, Ronald F. van VollenhovenOla Nived, Andreas Jönsen, Diane L. Kamen, Cynthia Aranow, Jorge Sanchez-Guerrero, Dafna D. Gladman, Paul R. Fortin, Graciela S. Alarcón, Joan T. Merrill, Kenneth Kalunian, Manuel Ramos-Casals, Kristján Steinsson, Asad Zoma, Anca Askanase, Munther A. Khamashta, Ian N. Bruce, Murat Inanc, Michal Abrahamowicz, Sasha Bernatsky

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)370-378
Number of pages9
JournalAnnals of the rheumatic diseases
Volume81
Issue number3
DOIs
StatePublished - Mar 1 2022

Keywords

  • autoimmune diseases
  • epidemiology
  • hydroxychloroquine
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

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