Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus.
Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus.
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DOI：
10.1161/circulationaha.111.089268
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发表时间：
2012-07-03
期刊：
影响因子：
37.8
通讯作者：
Buyon JP
中科院分区：
文献类型：
--
作者：
Izmirly PM;Costedoat-Chalumeau N;Pisoni CN;Khamashta MA;Kim MY;Saxena A;Friedman D;Llanos C;Piette JC;Buyon JP
最近的一项病例对照研究表明，羟基氯喹(HCQ)可降低抗SSA/Ro阳性系统性红斑狼疮(SLE)患者妊娠期间新生儿狼疮(心脏-NL)的心脏表现的风险。从三个国际数据库收集的历史队列被用来评估HCQ是否独立于母亲的健康状况而将心脏病-NL的复发风险降低近十倍。从三个数据库(美国、英国和法国)确定了257例抗SSA/Ro阳性母亲(40例暴露于HCQ，217例未暴露于HCQ)在出生后出生的心脏-NL。暴露被定义为在怀孕十周前开始在整个怀孕期间持续使用氢氯喹酮。暴露组胎儿心脏NL复发率为7.5%(3/40)，对照组为21.2%(46/217)(P=0.050)。虽然暴露组没有死亡，但非暴露组心脏NL胎儿的总病死率为22%。在调整了数据库来源、母亲种族/民族和抗SSB/La状态的多变量分析中，使用HCQ仍然与心脏NL风险的降低显著相关(优势比=0.23；95%CI：0.06-0.92；p=0.037)。倾向评分分析也得到了类似的结果，这是根据适应症调整可能的混淆的另一种方法。根据一项多国努力的汇总数据，在生下患有心脏NL的孩子的高危母亲中，使用HCQ可能会防止在随后的怀孕中疾病复发。
A recent case control study suggested a benefit of hydroxychloroquine (HCQ) in lowering the risk of cardiac manifestations of neonatal lupus (cardiac-NL) in pregnancies of anti-SSA/Ro positive patients with Systemic Lupus Erythematosus (SLE). A historical cohort assembled from three international databases was used to evaluate whether HCQ reduces the nearly tenfold increase in risk of recurrence of cardiac-NL, independent of maternal health status. Two hundred fifty seven pregnancies of anti-SSA/Ro positive mothers (40 exposed and 217 unexposed to HCQ) subsequent to the birth of a child with cardiac-NL were identified from three databases (U.S., England, and France). Exposure was defined as the sustained use of HCQ throughout pregnancy with initiation prior to ten weeks of gestation. The recurrence rate of cardiac-NL in fetuses exposed to HCQ was 7.5% (3/40) compared to 21.2% (46/217) in the unexposed group (p=0.050). While there were no deaths in the exposed group, the overall case fatality rate of the cardiac-NL fetuses in the unexposed group was 22%. In a multivariable analysis which adjusted for database source, maternal race/ethnicity, and anti-SSB/La status, HCQ use remained significantly associated with a decreased risk of cardiac-NL (Odds Ratio=0.23; 95% CI: 0.06–0.92; p=0.037). Similar results were obtained with propensity score analysis, an alternative approach to adjust for possible confounding by indication. Based on aggregate data from a multinational effort, in mothers at high risk of having a child with cardiac-NL, the use of HCQ may protect against recurrence of disease in a subsequent pregnancy.