Arthritis Research Canada, Vancouver, and Simon Fraser University, Burnaby, British Columbia, Canada.
Arthritis Research Canada, Vancouver, and University of British Columbia, Vancouver, British Columbia, Canada.
Arthritis Care Res (Hoboken). 2022 Jul;74(7):1089-1097. doi: 10.1002/acr.24550. Epub 2022 Apr 6.
To assess the association of antimalarial (AM) adherence with premature mortality among incident systemic lupus erythematosus (SLE) patients.
All patients with incident SLE and incident AM use in British Columbia, Canada, between January 1997 and March 2015 were identified using the provincial administrative databases. Follow-up started on the first day of having both SLE and AM. The outcome was all-cause mortality. An adherence measure, proportion of days covered (PDC), was calculated and categorized as adherent (PDC ≥ 0.90), nonadherent (0 < PDC < 0.90), and discontinuer (PDC = 0) during 30-day windows. We first used Cox models for time-to-death, adjusting for baseline and time-varying confounders on medication usages, health care utilization, and comorbidities. We then used marginal structural Cox models via inverse probability weighting designed for causal inference with time-varying confounders to assess the effect of AM adherence on premature mortality.
We identified 3,062 individuals with incident SLE and incident AM use (mean age 46.9 years). Over the mean follow-up period of 6.4 years, 242 (7.9%) of those patients died. Adjusted hazard ratios (HR ) from the Cox model for AM adherent and nonadherent SLE patients were 0.20 (95% confidence interval [95% CI] 0.13-0.29) and 0.62 (95% CI 0.42-0.91), respectively, compared to discontinuers. The corresponding HR from the marginal structural Cox model were 0.17 (95% CI 0.12-0.25) and 0.58 (95% CI 0.40-0.85), respectively. A significant trend in the HR of mortality risk over the adherence levels was found (P < 0.001).
Patients with SLE adhering to AM therapy had a 71% and 83% lower risk of death than patients who do not adhere or who discontinued AMs, respectively.
评估抗疟药物（AM）依从性与系统性红斑狼疮（SLE）患者过早死亡的相关性。
利用加拿大不列颠哥伦比亚省的省级行政数据库，确定了 1997 年 1 月至 2015 年 3 月期间所有新发 SLE 患者和新发 AM 使用患者。随访从同时患有 SLE 和 AM 的第一天开始。结局为全因死亡率。计算了一个依从性测量指标，即覆盖天数比例（PDC），并将其分为 30 天窗内的依从组（PDC≥0.90）、不依从组（0<PDC<0.90）和停药组（PDC=0）。我们首先使用 Cox 模型进行生存时间分析，调整了药物使用、医疗保健利用和合并症的基线和时变混杂因素。然后，我们使用了通过逆概率加权设计的用于处理时变混杂因素的边际结构 Cox 模型来评估 AM 依从性对过早死亡率的影响。
我们共纳入了 3062 名新发 SLE 患者和新发 AM 使用患者（平均年龄 46.9 岁）。在平均 6.4 年的随访期间，242 名（7.9%）患者死亡。Cox 模型中，与停药组相比，AM 依从和不依从 SLE 患者的调整后危险比（HR）分别为 0.20（95%置信区间 [95%CI] 0.13-0.29）和 0.62（95%CI 0.42-0.91）。边际结构 Cox 模型的相应 HR 分别为 0.17（95%CI 0.12-0.25）和 0.58（95%CI 0.40-0.85）。在依从水平上，死亡率风险的 HR 呈显著趋势（P<0.001）。
与不依从或停药的患者相比，接受 AM 治疗的 SLE 患者死亡风险分别降低了 71%和 83%。
