Longterm Hydroxychloroquine Therapy and Low-dose Aspirin May Have an Additive Effectiveness in the Primary Prevention of Cardiovascular Events in Patients with Systemic Lupus Erythematosus

Abstract

Our results suggest that prolonged use of HCQ plus ASA is thromboprotective in SLE and provides additional evidence for its continued use in patients with SLE.

Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology

“…By contrast, treatment with hydroxy chloroquine seems to counter these effects and provide long term benefits by reducing the risk of cardiovascular events, lowering fasting glucose levels 113 and reducing hyperlipidaemia 15,114 . For example, in a study of patients with SLE, combined use of low dose aspirin and hydroxy chloroquine was superior to treatment with aspirin or hydroxychloroquine alone in terms of preventing cardio vascular complications 115 . However, sufficiently large and controlled studies are needed to quantify the benefit to risk profile of hydroxychloroquine in the prevention of cardiovascular complications in patients with rheumatic diseases and other non rheumatological cohorts 116 .…”

Type-I interferons in atherosclerosis

“…Whereas the relation between immunosuppressive steroids and atherosclerosis remains controversial (Wu et al, 2016), hydroxychloroquine (HCQ), an alkalinizing lysosomatropic drug for SLE treatment, has been attested to be atheroprotective and is effective in dampening disease activity and mortality, reducing required steroids dosages, and preventing organ damage accrual and thrombovascular events ( Fig. 3; Fasano et al, 2017;Ponticelli and Moroni, 2017;Yang et al, 2019). Mechanistically, the atheroprotective effects of HCQ may be due to interfering with IFN-α and TNF production by TLR7/TLR9activated pDCs in SLE individuals (Table 1 and Fig.…”

According to the 2019 updated European League Against Rheumatism (EULAR) recommendations for the treatment of systemic lupus erythematosus: debatable issues and comments

“…Применение низких доз аспирина уменьшает риск сердечно-сосудистых событий при СКВ [относительный риск (ОР) -0,24, ретроспективное исследование], и его можно использовать для первичной профилактики сердечно-сосудистых осложнений (ССО) [144,145]. Однако у пациентов с сахарным диабетом и у пожилых людей применение аспирина не только не уменьшает вероятность возникновения ССО, но и повышает риск развития кровотечений [131,146].…”