Hsu Chung-Yuan, Lin Yu-Sheng, Su Yu-Jih, Lin Hsing-Fen, Lin Ming-Shyan, Syu Ya-Jhu, Cheng Tien-Tsai, Yu Shan-Fu, Chen Jia-Feng, Chen Tien-Hsing
Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung.
Division of Cardiology, Chang Gung Memorial Hospital, Chiayi.
Rheumatology (Oxford). 2017 Dec 1;56(12):2212-2221. doi: 10.1093/rheumatology/kex357.
The incidence of thromboembolism in patients with SLE is higher than that in the general population. HCQ, widely used to treat lupus, may have vascular protective effects. The aim of this study was to determine whether long-term HCQ exposure is associated with decreased thromboembolism risk in SLE.
We designed a prospective cohort study within an SLE population based on the National Health Insurance Research Database in Taiwan. We divided participants into HCQ and control groups according to HCQ prescription during the first year. These groups were defined by medication possession ratio (MPR) ⩾80% and MPR = 0%, respectively. Patients with an MPR between 0 and 80% were excluded. The primary outcome was a composite vascular event, including acute coronary syndrome, ischaemic stroke, pulmonary embolism, deep vein thrombosis and peripheral arterial disease 1 year after inclusion. We excluded patients from the cohort if they had outcomes within the first year.
A total of 8397 patients were eligible for analysis. After propensity-score matching, we included 1946 patients in each group. During a mean follow-up of 7.4 years, the number of events was 139 in the HCQ group (7.1%) and 149 in the control group (7.7%). The risk of vascular events in the HCQ group was similar to that in the control group (hazard ratio = 0.91; 95% CI: 0.72, 1.15). Further subgroup analyses confirmed no statistically significant differences between the groups.
Long-term HCQ appears to have no vascular protective effect in patients with SLE.
系统性红斑狼疮（SLE）患者血栓栓塞的发生率高于普通人群。广泛用于治疗狼疮的羟氯喹（HCQ）可能具有血管保护作用。本研究的目的是确定长期使用HCQ是否与SLE患者血栓栓塞风险降低相关。
我们基于台湾国民健康保险研究数据库，在SLE人群中设计了一项前瞻性队列研究。根据第一年的HCQ处方将参与者分为HCQ组和对照组。这些组分别由药物持有率（MPR）≥80%和MPR = 0%定义。MPR在0至80%之间的患者被排除。主要结局是复合血管事件，包括纳入后1年的急性冠状动脉综合征、缺血性中风、肺栓塞、深静脉血栓形成和外周动脉疾病。如果患者在第一年内出现结局，则将其从队列中排除。
共有8397例患者符合分析条件。经过倾向得分匹配后，每组纳入1946例患者。在平均7.4年的随访期间，HCQ组的事件数为139例（7.1%），对照组为149例（7.7%）。HCQ组血管事件的风险与对照组相似（风险比 = 0.91；95%置信区间：0.72，1.15）。进一步的亚组分析证实两组之间无统计学显著差异。
长期使用HCQ对SLE患者似乎没有血管保护作用。
