Impact of systemic lupus erythematosus disease activity, hydroxychloroquine and NSAID on the risk of subsequent organ system damage and death: analysis in a single US medical centre
Abstract:ObjectiveTo assess the impact of mild-moderate systemic lupus erythematosus (SLE) disease activity during a 12-month period on the risk of death or subsequent organ system damage.Methods1168 patients with ≥24 months of follow-up from the Hopkins Lupus Cohort were included. Disease activity in a 12-month observation period was calculated using adjusted mean Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) version of the SLE Disease Activity Index (SLEDAI), defined as the area under the cu… Show more
“…Table 1 also summarized the risk of bias in these 21 studies. Eighteen studies scored 6 or more points according to the NOS criteria 7,9,11,13,14,18–22,25–30,32,33 and therefore had a low risk of bias or high quality. Three studies scored four and had a high risk of bias or low quality.…”
Section: Resultsmentioning
confidence: 99%
“…Twenty-one studies were included in the final meta-analysis. 7,9,11,13,14,18–33 Figure 1.Study selection flowchart.…”
Section: Resultsmentioning
confidence: 99%
“…The number of published randomized controlled trials (RCTs) is much smaller than the number of cohort studies. 5 Much of the data on the benefits of HCQ have been generated from prospective SLE cohorts, for instance, the LUMINA (Lupus in Minorities: Nature vs Nurture) Cohort, 6,7 Toronto Lupus Cohort, 8,9 GLADEL (multinational Latin American lupus) Cohort, 10,11 Hopkins Lupus Cohort, 12,13 and Jiangsu Cohort. 14,15 In these cohort studies, HCQ not only had a protective effect against accrual damage 16 but was also associated with a shorter hospital stay 17 .…”
Objective Hydroxychloroquine (HCQ) is widely used in patients with systemic lupus erythematosus (SLE), but its effects on the mortality have not reached a definite conclusion. In this systematic review and meta-analysis, we aimed to assess whether HCQ use could reduce the risk of mortality in SLE patients. Methods PubMed, Embase, Web of Science, and Cochrane database were searched from inception to April 17, 2022 without language restrictions to explore the relationship between HCQ use and SLE mortality. The relative risk (HR) was pooled using the STATA software. Results A total of 21 studies with a pooled patient population of 26,037 were included in the study, including 14 studies on the association between HCQ alone and mortality risk and seven studies on the association between HCQ/chloroquine (CQ) and mortality risk. The pooled findings suggested that HCQ significantly reduced the overall mortality risk of SLE (pooled HR 0.46, 95% CI 0.38–0.57, p < 0.001). In subgroup analysis of SLE complications, HCQ use also decreased the risk of death in SLE patients with renal (HR=0.43, 95% CI 0.26–0.70, p = 0.001) and cardiopulmonary involvement (HR=0.37, 95% CI= 0.25–0.54, p < 0.001). In addition, HCQ use was also protective against the risk of mortality in SLE patients in different regions, such as Asia (HR=0.46, 95% CI=0.33–0.64, p < 0.001), Europe (HR= 0.40, 95% CI = 0.22–0.71, p = 0.002), and America (HR=0.52, 95% CI= 0.42–0.64, p < 0.001). Conclusion Our data suggested that HCQ use was associated with a reduced risk of mortality in patients with SLE.
“…Table 1 also summarized the risk of bias in these 21 studies. Eighteen studies scored 6 or more points according to the NOS criteria 7,9,11,13,14,18–22,25–30,32,33 and therefore had a low risk of bias or high quality. Three studies scored four and had a high risk of bias or low quality.…”
Section: Resultsmentioning
confidence: 99%
“…Twenty-one studies were included in the final meta-analysis. 7,9,11,13,14,18–33 Figure 1.Study selection flowchart.…”
Section: Resultsmentioning
confidence: 99%
“…The number of published randomized controlled trials (RCTs) is much smaller than the number of cohort studies. 5 Much of the data on the benefits of HCQ have been generated from prospective SLE cohorts, for instance, the LUMINA (Lupus in Minorities: Nature vs Nurture) Cohort, 6,7 Toronto Lupus Cohort, 8,9 GLADEL (multinational Latin American lupus) Cohort, 10,11 Hopkins Lupus Cohort, 12,13 and Jiangsu Cohort. 14,15 In these cohort studies, HCQ not only had a protective effect against accrual damage 16 but was also associated with a shorter hospital stay 17 .…”
Objective Hydroxychloroquine (HCQ) is widely used in patients with systemic lupus erythematosus (SLE), but its effects on the mortality have not reached a definite conclusion. In this systematic review and meta-analysis, we aimed to assess whether HCQ use could reduce the risk of mortality in SLE patients. Methods PubMed, Embase, Web of Science, and Cochrane database were searched from inception to April 17, 2022 without language restrictions to explore the relationship between HCQ use and SLE mortality. The relative risk (HR) was pooled using the STATA software. Results A total of 21 studies with a pooled patient population of 26,037 were included in the study, including 14 studies on the association between HCQ alone and mortality risk and seven studies on the association between HCQ/chloroquine (CQ) and mortality risk. The pooled findings suggested that HCQ significantly reduced the overall mortality risk of SLE (pooled HR 0.46, 95% CI 0.38–0.57, p < 0.001). In subgroup analysis of SLE complications, HCQ use also decreased the risk of death in SLE patients with renal (HR=0.43, 95% CI 0.26–0.70, p = 0.001) and cardiopulmonary involvement (HR=0.37, 95% CI= 0.25–0.54, p < 0.001). In addition, HCQ use was also protective against the risk of mortality in SLE patients in different regions, such as Asia (HR=0.46, 95% CI=0.33–0.64, p < 0.001), Europe (HR= 0.40, 95% CI = 0.22–0.71, p = 0.002), and America (HR=0.52, 95% CI= 0.42–0.64, p < 0.001). Conclusion Our data suggested that HCQ use was associated with a reduced risk of mortality in patients with SLE.
“…Data from cross-sectional, real-world studies from United States (US) insurance claims databases have reported antimalarial use ranging from 43% to 59%, corticosteroids 48% to 69%, immunosuppressants 18% to 26%, NSAIDs 35% to 38%, and biologics at approximately 3% [ 13 – 16 ]. The negative effect that corticosteroids [ 17 ] and NSAIDs [ 18 ] have on the cardiovascular system is now well studied. Evidence from research has demonstrated that patients with relatively stable, mild-to-moderate SLE disease activity accrued damage, especially in patients with chronic use of NSAIDs commonly taken to reduce MSK pain, which resulted in an increased risk of cardiovascular damage accrual [ 18 ].…”
Section: Discussionmentioning
confidence: 99%
“…The negative effect that corticosteroids [ 17 ] and NSAIDs [ 18 ] have on the cardiovascular system is now well studied. Evidence from research has demonstrated that patients with relatively stable, mild-to-moderate SLE disease activity accrued damage, especially in patients with chronic use of NSAIDs commonly taken to reduce MSK pain, which resulted in an increased risk of cardiovascular damage accrual [ 18 ].…”
Introduction
Musculoskeletal (MSK) symptoms, including arthritis and arthralgia, are common manifestations of systemic lupus erythematosus (SLE); definitions of activity patterns in SLE differ across studies. This study described clinical characteristics and treatment patterns of patients with SLE-MSK over time and by disease activity patterns from a real-world setting.
Methods
This retrospective descriptive analysis includes a subset of patients with SLE from the Hopkins Lupus Cohort with identified MSK involvement by scores on the arthritis domain of the Safety of Estrogens in Systemic Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) or Lupus Activity Index. Clinical characteristics and treatment patterns were described for patients with at least two visits over the observation period (2010–2019) for the SLE-MSK population based on three disease activity patterns: chronically active (MSK-CA), relapsing–remitting (MSK-RR), and long quiescence (MSK-LQ).
Results
The SLE-MSK subpopulation included 664 patients (4069 person-years). The most frequently used medications over the observation period were antimalarials (95%), corticosteroids (92%), immunosuppressants (58%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (48%); 7% of patients used biologics. The highest use of corticosteroids was in the MSK-CA group (90.5% of follow-up time), followed by MSK- RR (83.9%), and MSK-LQ (46.5%). Mean prednisone dose was significantly higher in MSK-RR (8.5 mg) compared to MSK-CA (6.5 mg).
Conclusions
This descriptive analysis highlights the impact of prevalent manifestations such as arthritis on the chronic use of corticosteroids, immunosuppressants, and NSAIDs to manage disease activity in patients with SLE, suggesting there is a need for new therapeutic options that enable a lower use of medication when treating lupus.
Supplementary Information
The online version contains supplementary material available at 10.1007/s12325-022-02148-8.
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