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dc.contributor.authorAlmeida-Brasil, Celline C
dc.contributor.authorHanly, John G
dc.contributor.authorUrowitz, Murray
dc.contributor.authorClarke, Ann Elaine
dc.contributor.authorRuiz-Irastorza, Guillermo
dc.contributor.authorGordon, Caroline
dc.contributor.authorRamsey-Goldman, Rosalind
dc.contributor.authorPetri, Michelle
dc.contributor.authorGinzler, Ellen M
dc.contributor.authorWallace, D J
dc.contributor.authorBae, Sang-Cheol
dc.contributor.authorRomero-Diaz, Juanita
dc.contributor.authorDooley, Mary Anne
dc.contributor.authorPeschken, Christine
dc.contributor.authorIsenberg, David
dc.contributor.authorRahman, Anisur
dc.contributor.authorManzi, Susan
dc.contributor.authorJacobsen, Søren
dc.contributor.authorLim, Sam
dc.contributor.authorvan Vollenhoven, Ronald F
dc.contributor.authorNived, Ola
dc.contributor.authorJönsen, Andreas
dc.contributor.authorKamen, Diane L
dc.contributor.authorAranow, Cynthia
dc.contributor.authorSanchez-Guerrero, Jorge
dc.contributor.authorGladman, Dafna D
dc.contributor.authorFortin, Paul R
dc.contributor.authorAlarcón, Graciela S
dc.contributor.authorMerrill, Joan T
dc.contributor.authorKalunian, Kenneth
dc.contributor.authorRamos-Casals, Manuel
dc.contributor.authorSteinsson, Kristján
dc.contributor.authorZoma, Asad
dc.contributor.authorAskanase, Anca
dc.contributor.authorKhamashta, Munther A
dc.contributor.authorBruce, Ian N
dc.contributor.authorInanc, Murat
dc.contributor.authorAbrahamowicz, Michal
dc.contributor.authorBernatsky, Sasha
dc.date.accessioned2023-01-11T19:24:39Z
dc.date.available2023-01-11T19:24:39Z
dc.date.issued2021-12-15
dc.identifier.citationAlmeida-Brasil CC, Hanly JG, Urowitz M, Clarke AE, Ruiz-Irastorza G, Gordon C, Ramsey-Goldman R, Petri M, Ginzler EM, Wallace DJ, Bae SC, Romero-Diaz J, Dooley MA, Peschken C, Isenberg D, Rahman A, Manzi S, Jacobsen S, Lim S, van Vollenhoven RF, Nived O, Jönsen A, Kamen DL, Aranow C, Sanchez-Guerrero J, Gladman DD, Fortin PR, Alarcón GS, Merrill JT, Kalunian K, Ramos-Casals M, Steinsson K, Zoma A, Askanase A, Khamashta MA, Bruce IN, Inanc M, Abrahamowicz M, Bernatsky S. Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Ann Rheum Dis. 2022 Mar;81(3):370-378. doi: 10.1136/annrheumdis-2021-221295. Epub 2021 Dec 15. PMID: 34911705; PMCID: PMC8862090.en_US
dc.identifier.eissn1468-2060
dc.identifier.doi10.1136/annrheumdis-2021-221295
dc.identifier.pmid34911705
dc.identifier.urihttp://hdl.handle.net/20.500.12648/8089
dc.description.abstractTo evaluate systemic lupus erythematosus (SLE) flares following hydroxychloroquine (HCQ) reduction or discontinuation versus HCQ maintenance.
dc.description.abstractWe 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.
dc.description.abstractWe 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.
dc.description.abstractSLE 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.
dc.language.isoenen_US
dc.relation.urlhttps://ard.bmj.com/content/81/3/370.longen_US
dc.rights© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectautoimmune diseasesen_US
dc.subjectepidemiologyen_US
dc.subjecthydroxychloroquineen_US
dc.subjectsystemic lupus erythematosusen_US
dc.titleFlares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort.en_US
dc.typeArticle/Reviewen_US
dc.source.journaltitleAnnals of the rheumatic diseasesen_US
dc.source.volume81
dc.source.issue3
dc.source.beginpage370
dc.source.endpage378
dc.source.countryUnited Kingdom
dc.source.countryCanada
dc.source.countryUnited Kingdom
dc.source.countryEngland
dc.description.versionVoRen_US
refterms.dateFOA2023-01-11T19:24:40Z
html.description.abstractTo evaluate systemic lupus erythematosus (SLE) flares following hydroxychloroquine (HCQ) reduction or discontinuation versus HCQ maintenance.
html.description.abstractWe 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.
html.description.abstractWe 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.
html.description.abstractSLE 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.
dc.description.institutionSUNY Downstateen_US
dc.description.departmentRheumatologyen_US
dc.description.degreelevelN/Aen_US
dc.identifier.journalAnnals of the rheumatic diseases


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© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
Except where otherwise noted, this item's license is described as © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.