Systemic lupus erythematosus in three ethnic groups -: XVI.: Association of hydroxychloroquine use with reduced risk of damage accrual
Systemic lupus erythematosus in three ethnic groups -: XVI.: Association of hydroxychloroquine use with reduced risk of damage accrual
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DOI：
10.1002/art.21039
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发表时间：
2005-05-01
影响因子：
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通讯作者：
Reveille, JD
中科院分区：
文献类型：
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作者：
Fessler, BJ;Alarcón, GS;Reveille, JD
Objective.研究系统性红斑狼疮（SLE）患者使用羟氯喹（HCQ）是否与损害累积风险降低相关。符合美国流变学学会诊断SLE标准的患者（n = 518），入组研究时病程> 55年，每年随访一次。测量了社会经济学、人口统计学、临床和血清学表现以及疾病活动性（通过系统性狼疮活动性测量[SLAM]）和损害（通过系统性狼疮国际合作临床损害指数[SDI]）。计算倾向评分，以调整影响治疗分配的混杂因素。采用考克斯比例风险模型，根据入组研究时HCQ的使用情况，比较发生新损伤的风险。五十六%的患者在研究入组时接受了HCQ治疗。入组时未接受HCQ治疗的患者的SLAM和SDI评分高于接受治疗的患者。未经治疗的患者更可能发生主要器官受累，如肾脏疾病（P 0.0001）或中枢神经系统疾病（P 0.0025）。未校正的分析结果表明，接受治疗的患者不太可能累积损伤（风险比[HR] 0.68）。调整治疗分配差异后，HCQ的使用仍与发生新损伤的风险降低相关，HR为0.68（95%置信区间[95% CI] 0.53-0.93）（P = 0.014）。调整治疗分配差异后，HCQ使用仍与发生新损伤的风险降低相关（HR 0.73 [95% CI 0.52-1.00]）（P = 0.05）。然而，接受HCQ治疗的患者在研究入组时无损伤，其损伤累积风险显著降低（HR 0.55 [95%CI 0.34-0.871]，P = 0.0111），而接受HCQ治疗的患者在研究入组时有损伤，其损伤累积风险无显著降低（HR 1.106 [95%CI 0.70-1.74]，P = 0.6630）。这些结果表明，在调整接受HCQ的倾向后，HCQ的使用与在治疗开始时尚未累积损伤的SLE患者的损伤累积风险降低独立相关。
Objective. To examine whether hydroxychloroquine (HCQ) usage is associated with a reduced risk of damage accrual in patients with systemic lupus erythematosus (SLE).Methods. Patients (n = 518) meeting the American College of Rheumatology criteria for diagnosis SLE and with :55 years disease duration at study entry were followed up annually. Socioeconomic, demographic, clinical, and serologic manifestations as well as disease activity (by the Systemic Lupus Activity Measure [SLAM]) and damage (by the Systemic Lupus International Collaborating Clinics damage index [SDI]) were measured. Propensity scores were calculated to adjust for confounding factors affecting treatment assignment. A Cox proportional hazards model was used to compare the risk of developing new damage according to HCQ use at enrollment into the study.Results. Fifty-six percent of the patients were treated with HCQ at the time of study enrollment. Patients who were not treated with HCQ on enrollment had higher SLAM and SDI scores than patients who were treated. Untreated patients were significantly more likely to have major organ involvement such as renal disease (P < 0.0001) or central nervous system disease (P < 0.0025). Results of unadjusted analysis suggested that treated patients were less likely to accrue damage (hazard ratio [HR] 0.68). With adjustment for differences in treatment assignment, HCQ usage was still associated with a reduced risk of developing new damage, with an HR of 0.68 (95% confidence interval [95% CI] 0.53-0.93) (P = 0.014). With adjustment for differences in treatment assignment, HCQ usage was still associated with a reduced risk of developing new damage (HR 0.73 [95% CI 0.52-1.00]) (P = 0.05). However, patients receiving HCQ who had no damage at study entry had a statistically significant decrease in the risk of damage accrual (HR 0.55 [95% CI 0.34-0.871) (P = 0.0111), whereas those receiving HCQ who had damage at study entry did not (HR 1.106 [95% CI 0.70-1.74]) (P = 0.6630).Conclusion. These findings indicate that, after adjustment for propensity to receive HCQ, HCQ usage is independently associated with a reduced risk of damage accrual in SLE patients who had not yet accrued damage at the time of treatment initiation.