Effect of in utero hydroxychloroquine exposure on the development of cutaneous neonatal lupus erythematosus

Abstract

ObjectiveCutaneous neonatal lupus (cNL) occurs in possibly 5%–16% of anti-Ro±anti-La antibody–exposed infants. Data suggest in utero exposure to hydroxychloroquine (HCQ) may prevent cardiac NL. The aim was to assess whether in utero exposure to HCQ decreases the risk of cNL and/or delays onset.MethodsA multicentre case–control study was performed with 122 cNL cases and 434 controls born to women with a rheumatological disease who had documentation of maternal anti-Ro±anti-La antibodies at pregnancy and confirmation of medication use and the child’s outcome. A secondary analysis was performed on 262 cNL cases, irrespective of maternal diagnosis, to determine if HCQ delayed time to cNL onset.ResultsTwenty (16%) cNL cases were exposed to HCQ compared with 146 (34%) controls (OR 0.4 (95% CI 0.2 to 0.6); p<0.01). Exposure to HCQ was associated with a reduced risk of cNL; exposure to anti-La antibody and female gender were associated with an increased risk of cNL. Exposure to HCQ remained significantly associated with a reduced cNL risk in the analyses limited to mothers with systemic lupus erythematosus and those who developed rash ≤1 month. When analysing all 262 cNL cases, HCQ-exposed infants were older (6.0 (95% CI 5.7 to 6.3) weeks) at cNL onset versus HCQ-non-exposed infants (4.4 (95% CI 3.9 to 5.0) weeks), but the difference was not statistically significant (p=0.21).ConclusionExposure to HCQ was associated with a reduced risk of cNL. Among cNL cases, those exposed to HCQ tend to have later onset of rash. Both findings suggest a protective effect of HCQ on cNL.

A review of fetal and neonatal consequences of maternal systemic lupus erythematosus

“…Cutaneous involvement is one of the most common noncardiac manifestations of NL, affecting 5% to 16% of fetuses born to mothers with autoantibodies, though the quality of data is poor with few prospective studies 46,47,50,90,91 . It has been recently reported that HCQ may reduce the risk of cutaneous disease 92 …”

Discontinuation of hydroxychloroquine in older patients with systemic lupus erythematosus: a multicenter retrospective study

“…Antimalarials are among the most frequently prescribed medications in systemic lupus erythematosus (SLE). The use of antimalarials, in particular hydroxychloroquine (HCQ), has been associated with numerous benefits: reduction of flares, including during pregnancy [1,2]; reduction of the risk of neonatal lupus [3][4][5][6]; protection against organ damage [7][8][9]; reduction of the risk of thrombosis [10][11][12][13][14]; improvement in lipid profile [13,15,16]; hyperglycemia [17]; bone mineral density [18]; and survival [14,19,20].…”

Discontinuation of hydroxychloroquine in older patients with Systemic Lupus Erythematosus: A multicenter retrospective study

“…Antimalarials are among the most frequently prescribed medications in Systemic Lupus Erythematosus (SLE). The use of antimalarials, in particular hydroxychloroquine (HCQ), has been associated with numerous bene ts: reduction of ares, including during pregnancy [1,2], reduction of the risk of neonatal lupus [3][4][5][6], protection against organ damage [7][8][9], reduction of the risk of thrombosis [10][11][12][13][14], improvement in lipid pro le [13,15,16], hyperglycemia [17], bone mineral density [18], and survival [14,19,20].…”