The Protective Effect of Antimalarial Drugs on Thrombovascular Events in Systemic Lupus Erythematosus
The Protective Effect of Antimalarial Drugs on Thrombovascular Events in Systemic Lupus Erythematosus
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DOI：
10.1002/art.27289
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发表时间：
2010-03-01
影响因子：
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通讯作者：
Fortin, Paul R.
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文献类型：
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作者：
Jung, Hyejung;Bobba, Raja;Fortin, Paul R.
Objective.抗疟药羟氯喹已被提议作为系统性红斑狼疮（SLE）的血栓保护剂，但迄今为止的研究受到了适应症混淆的可能性的限制。本研究旨在评估SLE患者暴露于抗疟药物是否与血栓事件（TE）减少相关。该研究设计为嵌入SLE患者初始队列的巢式病例对照研究，允许根据日历年、疾病持续时间、观察持续时间和狼疮严重程度调整可能的混杂因素。在控制了条件Logistic回归模型中可能的混杂变量后，评估抗疟药物的使用对狼疮患者TE发生的影响。确定了54例TE，并将其与108例对照受试者（无TE的狼疮患者）相匹配。单变量分析确定年龄较大（比值比[OR] 1.04，95%置信区间[95% CI] 1.01-1.07）或年龄大于50岁（OR 3.5，95% CI 1.4-8.6）且曾患有高血压（OR 2.5，95%CI 1.0-5.8）与TE风险增加相关，而使用抗疟药（OR 0.31，95% CI 0.13-0.71）与TE风险降低相关。对动脉和静脉TE进行了单独分析，得出了相似的结果。在多变量分析中，抗疟药物的使用（OR 0.32，95%CI 0.14-0.74）和年龄（OR 1.04，95%CI 1.01-1.07）是仅有的两个仍有意义的变量。这项巢式病例对照研究的结果表明，在考虑疾病严重程度、疾病持续时间和日历年的影响后，抗疟药物具有血栓保护作用，与所有TE风险降低68%相关，风险降低范围至少为26%，最高可达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 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%.