Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (LUMINA L)
- Graciela S Alarcón1,
- Gerald McGwin2,
- Ana M Bertoli1,
- Barri J Fessler1,
- Jaime Calvo-Alén1,
- Holly M Bastian1,
- Luis M Vilá3,
- John D Reveille4,
- for the LUMINA Study Group
- 1Department of Medicine (Division of Clinical Immunology and Rheumatology), School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- 2Departments of Surgery (Section of Trauma, Burns, and Critical Care), and Epidemiology Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- 3The University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
- 4Department of Medicine (Division of Rheumatology), The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Correspondence to:
Dr Graciela S Alarcón
The University of Alabama at Birmingham, 830 Faculty Office Tower, 510 20th Street South, Birmingham, Alabama 35294-3408, USA;
- Accepted 17 March 2007
- Published Online First 27 March 2007
Objective: In patients with systemic lupus erythematosus (SLE), hydroxychloroquine prevents disease flares and damage accrual and facilitates the response to mycophenolate mofetil in those with renal involvement. A study was undertaken to determine whether hydroxychloroquine also exerts a protective effect on survival.
Methods: Patients with SLE from the multiethnic LUMINA (LUpus in MInorities: NAture vs nurture) cohort were studied. A case-control study was performed within the context of this cohort in which deceased patients (cases) were matched for disease duration (within 6 months) with alive patients (controls) in a proportion of 3:1. Survival was the outcome of interest. Propensity scores were derived by logistic regression to adjust for confounding by indication as patients with SLE with milder disease manifestations are more likely to be prescribed hydroxychloroquine. A conditional logistic regression model was used to estimate the risk of death and hydroxychloroquine use with and without the propensity score as the adjustment variable.
Results: There were 608 patients, of whom 61 had died (cases). Hydroxychloroquine had a protective effect on survival (OR 0.128 (95% CI 0.054 to 0.301 for hydroxychloroquine alone and OR 0.319 (95% CI 0.118 to 0.864) after adding the propensity score). As expected, the propensity score itself was also protective.
Conclusions: Hydroxychloroquine, which overall is well tolerated by patients with SLE, has a protective effect on survival which is evident even after taking into consideration the factors associated with treatment decisions. This information is of importance to all clinicians involved in the care of patients with SLE.
Published Online First 27 March 2007
Supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases #R01-AR42503 and General Clinical Research Centers #M01-RR02558 (UTH-HSC) and M01-RR00032 (UAB) and from the National Center for Research Resources (NCRR/NIH) RCMI Clinical Research Infrastructure Initiative (RCRII) award 1P20RR11126 (UPR-MSC) and the Mary Kirkland Scholars Award Program (UAB).
Competing interests: None.
The first two authors contributed equally to the investigation.