OBJECTIVE: The antimalarial medication hydroxychloroquine has been proposed as a thromboprotective agent in systemic lupus erythematosus (SLE), but studies thus far have been limited by the possibility of confounding by indication. This study was conducted to assess whether exposure to antimalarial drugs is associated with a decrease in thrombovascular events (TEs) in patients with SLE. METHODS: The study was designed as a nested case-control study embedded in an inception cohort of patients with SLE, which allowed adjustments for possible confounding by calendar year, duration of disease, duration of observation, and severity of lupus. After controlling for the possible confounding variables in conditional logistic regression models, the use of antimalarial drugs was assessed for its effects on the development of TEs in lupus patients. RESULTS: Fifty-four cases of TE were identified, and these were matched with 108 control subjects (lupus patients without TEs). Univariate analyses identified older age (odds ratio [OR] 1.04, 95% confidence interval [95%CI] 1.01-1.07) or being older than age 50 years (OR 3.5, 95% CI 1.4-8.6) and ever having hypertension (OR 2.5, 95% CI 1.0-5.8) as being associated with an increased risk of TEs, whereas use of antimalarial drugs (OR 0.31, 95% CI 0.13-0.71) was associated with a decreased risk of TEs. Separate analyses were done for arterial and venous TEs, which yielded similar results. In multivariate analyses, use of antimalarial drugs (OR 0.32, 95% CI 0.14-0.74) and older age (OR 1.04, 95% CI 1.01-1.07) were the only 2 variables that remained significant. CONCLUSION: The results from this nested case-control study demonstrate that, after accounting for the effects of disease severity, disease duration, and calendar year, antimalarial drugs were found to be thromboprotective, being associated with a 68% reduction in the risk of all TEs, with a range of risk reduction of at least 26% up to as high as 86%.
OBJECTIVE: The antimalarial medication hydroxychloroquine has been proposed as a thromboprotective agent in systemic lupus erythematosus (SLE), but studies thus far have been limited by the possibility of confounding by indication. This study was conducted to assess whether exposure to antimalarial drugs is associated with a decrease in thrombovascular events (TEs) in patients with SLE. METHODS: The study was designed as a nested case-control study embedded in an inception cohort of patients with SLE, which allowed adjustments for possible confounding by calendar year, duration of disease, duration of observation, and severity of lupus. After controlling for the possible confounding variables in conditional logistic regression models, the use of antimalarial drugs was assessed for its effects on the development of TEs in lupuspatients. RESULTS: Fifty-four cases of TE were identified, and these were matched with 108 control subjects (lupuspatients without TEs). Univariate analyses identified older age (odds ratio [OR] 1.04, 95% confidence interval [95%CI] 1.01-1.07) or being older than age 50 years (OR 3.5, 95% CI 1.4-8.6) and ever having hypertension (OR 2.5, 95% CI 1.0-5.8) as being associated with an increased risk of TEs, whereas use of antimalarial drugs (OR 0.31, 95% CI 0.13-0.71) was associated with a decreased risk of TEs. Separate analyses were done for arterial and venous TEs, which yielded similar results. In multivariate analyses, use of antimalarial drugs (OR 0.32, 95% CI 0.14-0.74) and older age (OR 1.04, 95% CI 1.01-1.07) were the only 2 variables that remained significant. CONCLUSION: The results from this nested case-control study demonstrate that, after accounting for the effects of disease severity, disease duration, and calendar year, antimalarial drugs were found to be thromboprotective, being associated with a 68% reduction in the risk of all TEs, with a range of risk reduction of at least 26% up to as high as 86%.
Authors: Jürgen Braun; Klaus Krüger; Bernhard Manger; Matthias Schneider; Christof Specker; Hans Joachim Trappe Journal: Dtsch Arztebl Int Date: 2017-03-24 Impact factor: 5.594
Authors: Bevra H Hahn; Maureen A McMahon; Alan Wilkinson; W Dean Wallace; David I Daikh; John D Fitzgerald; George A Karpouzas; Joan T Merrill; Daniel J Wallace; Jinoos Yazdany; Rosalind Ramsey-Goldman; Karandeep Singh; Mazdak Khalighi; Soo-In Choi; Maneesh Gogia; Suzanne Kafaja; Mohammad Kamgar; Christine Lau; William J Martin; Sefali Parikh; Justin Peng; Anjay Rastogi; Weiling Chen; Jennifer M Grossman Journal: Arthritis Care Res (Hoboken) Date: 2012-06 Impact factor: 4.794
Authors: Jinoos Yazdany; Candace H Feldman; Jun Liu; Michael M Ward; Michael A Fischer; Karen H Costenbader Journal: Arthritis Care Res (Hoboken) Date: 2014-04 Impact factor: 4.794