Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus:: Data from LUMINA, a multiethnic US cohort (LUMINA L)
Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus:: Data from LUMINA, a multiethnic US cohort (LUMINA L)
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DOI：
10.1136/ard.2006.068676
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发表时间：
2007-09-01
影响因子：
27.4
通讯作者：
Reveille, John D.
中科院分区：
文献类型：
--
作者：
Alarcon, Graciela S.;McGwin, Gerald;Reveille, John D.
目的：在系统性红斑狼疮（SLE）患者中，羟氯喹可预防疾病发作和损害的累积，并促进肾受累患者对霉酚酸酯的反应。进行了一项研究，以确定羟氯喹是否也对生存有保护作用。方法：研究来自多民族LUMINA （LUpus in MInorities: NAture vs . nurture）队列的SLE患者。在该队列中进行了一项病例对照研究，其中死亡患者（病例）的病程（6个月内）与活着的患者（对照组）按3:1的比例进行匹配。生存是兴趣的结果。倾向评分是通过逻辑回归得出的，以调整适应症的混淆，因为疾病表现较轻的SLE患者更有可能开羟氯喹。采用条件logistic回归模型估计以倾向评分和不以倾向评分作为调整变量的死亡风险和羟氯喹使用风险。结果：共收治608例患者，死亡61例。羟氯喹对生存有保护作用(单独羟氯喹组OR为0.128 (95% Cl为0.054 ~ 0.301)，加倾向评分后OR为0.319 （95% Cl为0.118 ~ 0.864）。正如预期的那样，倾向评分本身也具有保护作用。结论：羟氯喹对SLE患者总体耐受良好，即使考虑到与治疗决策相关的因素，其对生存的保护作用也很明显。这一信息对所有参与SLE患者护理的临床医生都很重要。
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% Cl 0.054 to 0.301 for hydroxychloroquine alone and OR 0.319 ( 95% Cl 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.