Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort.
dc.contributor.author | Almeida-Brasil, Celline C | |
dc.contributor.author | Hanly, John G | |
dc.contributor.author | Urowitz, Murray | |
dc.contributor.author | Clarke, Ann Elaine | |
dc.contributor.author | Ruiz-Irastorza, Guillermo | |
dc.contributor.author | Gordon, Caroline | |
dc.contributor.author | Ramsey-Goldman, Rosalind | |
dc.contributor.author | Petri, Michelle | |
dc.contributor.author | Ginzler, Ellen M | |
dc.contributor.author | Wallace, D J | |
dc.contributor.author | Bae, Sang-Cheol | |
dc.contributor.author | Romero-Diaz, Juanita | |
dc.contributor.author | Dooley, Mary Anne | |
dc.contributor.author | Peschken, Christine | |
dc.contributor.author | Isenberg, David | |
dc.contributor.author | Rahman, Anisur | |
dc.contributor.author | Manzi, Susan | |
dc.contributor.author | Jacobsen, Søren | |
dc.contributor.author | Lim, Sam | |
dc.contributor.author | van Vollenhoven, Ronald F | |
dc.contributor.author | Nived, Ola | |
dc.contributor.author | Jönsen, Andreas | |
dc.contributor.author | Kamen, Diane L | |
dc.contributor.author | Aranow, Cynthia | |
dc.contributor.author | Sanchez-Guerrero, Jorge | |
dc.contributor.author | Gladman, Dafna D | |
dc.contributor.author | Fortin, Paul R | |
dc.contributor.author | Alarcón, Graciela S | |
dc.contributor.author | Merrill, Joan T | |
dc.contributor.author | Kalunian, Kenneth | |
dc.contributor.author | Ramos-Casals, Manuel | |
dc.contributor.author | Steinsson, Kristján | |
dc.contributor.author | Zoma, Asad | |
dc.contributor.author | Askanase, Anca | |
dc.contributor.author | Khamashta, Munther A | |
dc.contributor.author | Bruce, Ian N | |
dc.contributor.author | Inanc, Murat | |
dc.contributor.author | Abrahamowicz, Michal | |
dc.contributor.author | Bernatsky, Sasha | |
dc.date.accessioned | 2023-01-11T19:24:39Z | |
dc.date.available | 2023-01-11T19:24:39Z | |
dc.date.issued | 2021-12-15 | |
dc.identifier.citation | Almeida-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.eissn | 1468-2060 | |
dc.identifier.doi | 10.1136/annrheumdis-2021-221295 | |
dc.identifier.pmid | 34911705 | |
dc.identifier.uri | http://hdl.handle.net/20.500.12648/8089 | |
dc.description.abstract | To evaluate systemic lupus erythematosus (SLE) flares following hydroxychloroquine (HCQ) reduction or discontinuation versus HCQ maintenance. | |
dc.description.abstract | 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. | |
dc.description.abstract | 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. | |
dc.description.abstract | 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. | |
dc.language.iso | en | en_US |
dc.relation.url | https://ard.bmj.com/content/81/3/370.long | en_US |
dc.rights | © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. | |
dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 International | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | * |
dc.subject | autoimmune diseases | en_US |
dc.subject | epidemiology | en_US |
dc.subject | hydroxychloroquine | en_US |
dc.subject | systemic lupus erythematosus | en_US |
dc.title | Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. | en_US |
dc.type | Article/Review | en_US |
dc.source.journaltitle | Annals of the rheumatic diseases | en_US |
dc.source.volume | 81 | |
dc.source.issue | 3 | |
dc.source.beginpage | 370 | |
dc.source.endpage | 378 | |
dc.source.country | United Kingdom | |
dc.source.country | Canada | |
dc.source.country | United Kingdom | |
dc.source.country | England | |
dc.description.version | VoR | en_US |
refterms.dateFOA | 2023-01-11T19:24:40Z | |
html.description.abstract | To evaluate systemic lupus erythematosus (SLE) flares following hydroxychloroquine (HCQ) reduction or discontinuation versus HCQ maintenance. | |
html.description.abstract | 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. | |
html.description.abstract | 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. | |
html.description.abstract | 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. | |
dc.description.institution | SUNY Downstate | en_US |
dc.description.department | Rheumatology | en_US |
dc.description.degreelevel | N/A | en_US |
dc.identifier.journal | Annals of the rheumatic diseases |