Massachusetts General Hospital, Boston, Massachusetts.
Massachusetts General Hospital, Boston, Massachusetts, and Arthritis Research Canada, Richmond, British Columbia, Canada.
Arthritis Care Res (Hoboken). 2021 Aug;73(8):1219-1223. doi: 10.1002/acr.24255. Epub 2021 Jul 7.
Hydroxychloroquine (HCQ) has been associated with improved survival among patients with systemic lupus erythematosus (SLE) from tertiary referral centers. We aimed to determine the potential impact of HCQ use on the risk of mortality among SLE patients in the general population.
We conducted a nested case-control study within an incident SLE cohort from the entire population of British Columbia, Canada. Deceased patients were matched with up to 3 living controls by age, sex, and SLE disease duration. HCQ exposure was categorized by the time between the last HCQ prescription date covered (i.e., end of supply) and the index date (i.e., death date) as current (<30 days), recent (30-365 days), remote (>365 days), or never used. We used conditional logistic regression to assess the risk of all-cause mortality associated with current or recent HCQ exposure compared with remote HCQ users.
Among 6,241 patients with incident SLE, we identified 290 deceased patients and 502 matched SLE controls. Adjusted odd ratios for all-cause mortality were 0.50 (95% confidence interval [95% CI] 0.30-0.82) for current users and 2.47 (95% CI 1.21-5.05) for recent users compared with remote users. Associations were similar in subgroups according to SLE duration (≤5 years versus >5 years).
Our general population data support a substantial survival benefit associated with current HCQ use. Increased mortality among patients who had discontinued HCQ recently could be due to a sick stopper effect or the loss of actual HCQ benefits.
羟氯喹 (HCQ) 已被证明与三级转诊中心的系统性红斑狼疮 (SLE) 患者的生存率提高有关。我们旨在确定 HCQ 使用对普通人群中 SLE 患者的死亡率风险的潜在影响。
我们在加拿大不列颠哥伦比亚省的整个人群中进行了一项嵌套病例对照研究，其中包含了一个新发生的 SLE 队列。已故患者通过年龄、性别和 SLE 病程与最多 3 名存活对照相匹配。根据最后一次 HCQ 处方日期覆盖的时间（即供应结束）与索引日期（即死亡日期）之间的时间，将 HCQ 暴露分为当前（<30 天）、近期（30-365 天）、远期（>365 天）或从未使用。我们使用条件逻辑回归来评估与远程 HCQ 用户相比，当前或近期 HCQ 暴露与全因死亡率相关的风险。
在 6241 名新发生的 SLE 患者中，我们确定了 290 名死亡患者和 502 名匹配的 SLE 对照。与远程使用者相比，当前使用者的全因死亡率调整比值比为 0.50（95%置信区间 [95%CI] 0.30-0.82），近期使用者为 2.47（95%CI 1.21-5.05）。根据 SLE 病程（≤5 年与>5 年），亚组中的关联相似。
我们的普通人群数据支持当前 HCQ 使用与生存率显著提高有关。近期停止使用 HCQ 的患者死亡率增加可能是由于停药效应或实际 HCQ 益处的丧失。
