Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
Department of Internal Medicine, Cochin Hospital, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, AP-HP, Université Paris Descartes-Sorbonne Paris Cité, Paris, France.
Ann Rheum Dis. 2018 Dec;77(12):1742-1749. doi: 10.1136/annrheumdis-2018-213718. Epub 2018 Oct 8.
Cutaneous 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.
A 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.
Twenty (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).
Exposure 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.
新生儿狼疮（cNL）可能发生于 5%-16%的抗 Ro±抗 La 抗体暴露婴儿中。数据表明，胎儿期暴露于羟氯喹（HCQ）可能预防心脏 NL。本研究旨在评估胎儿期暴露于 HCQ 是否降低 cNL 的风险和/或延迟发病。
进行了一项多中心病例对照研究，纳入了 122 例 cNL 病例和 434 例母亲患有风湿病且在妊娠时具有抗 Ro±抗 La 抗体记录并证实使用了药物且有儿童结局的对照。对 262 例无论母亲诊断如何的 cNL 病例进行了二次分析，以确定 HCQ 是否延迟了 cNL 发病时间。
20 例（16%）cNL 病例暴露于 HCQ，而 146 例（34%）对照暴露于 HCQ（比值比 0.4（95%CI 0.2 至 0.6）；p<0.01）。暴露于 HCQ 与 cNL 风险降低相关；暴露于抗 La 抗体和女性性别与 cNL 风险增加相关。在仅分析系统性红斑狼疮母亲和发病时间≤1 个月的母亲时，HCQ 暴露仍与 cNL 风险降低显著相关。在分析所有 262 例 cNL 病例时，HCQ 暴露婴儿的 cNL 发病年龄较大（6.0（95%CI 5.7 至 6.3）周），而 HCQ 非暴露婴儿的发病年龄较小（4.4（95%CI 3.9 至 5.0）周），但差异无统计学意义（p=0.21）。
HCQ 暴露与 cNL 风险降低相关。在 cNL 病例中，暴露于 HCQ 的婴儿发病较晚。这两种发现均提示 HCQ 对 cNL 具有保护作用。
