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Antimalarial treatment may have a time-dependent effect on lupus survival: data from a multinational Latin American inception cohort.
Arthritis Rheum 2010; 62(3):855-62AR

Abstract

OBJECTIVE

To evaluate the beneficial effect of antimalarial treatment on lupus survival in a large, multiethnic, international longitudinal inception cohort.

METHODS

Socioeconomic and demographic characteristics, clinical manifestations, classification criteria, laboratory findings, and treatment variables were examined in patients with systemic lupus erythematosus (SLE) from the Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohort. The diagnosis of SLE, according to the American College of Rheumatology criteria, was assessed within 2 years of cohort entry. Cause of death was classified as active disease, infection, cardiovascular complications, thrombosis, malignancy, or other cause. Patients were subdivided by antimalarial use, grouped according to those who had received antimalarial drugs for at least 6 consecutive months (user) and those who had received antimalarial drugs for <6 consecutive months or who had never received antimalarial drugs (nonuser).

RESULTS

Of the 1,480 patients included in the GLADEL cohort, 1,141 (77%) were considered antimalarial users, with a mean duration of drug exposure of 48.5 months (range 6-98 months). Death occurred in 89 patients (6.0%). A lower mortality rate was observed in antimalarial users compared with nonusers (4.4% versus 11.5%; P< 0.001). Seventy patients (6.1%) had received antimalarial drugs for 6-11 months, 146 (12.8%) for 1-2 years, and 925 (81.1%) for >2 years. Mortality rates among users by duration of antimalarial treatment (per 1,000 person-months of followup) were 3.85 (95% confidence interval [95% CI] 1.41-8.37), 2.7 (95% CI 1.41-4.76), and 0.54 (95% CI 0.37-0.77), respectively, while for nonusers, the mortality rate was 3.07 (95% CI 2.18-4.20) (P for trend < 0.001). After adjustment for potential confounders in a Cox regression model, antimalarial use was associated with a 38% reduction in the mortality rate (hazard ratio 0.62, 95% CI 0.39-0.99).

CONCLUSION

Antimalarial drugs were shown to have a protective effect, possibly in a time-dependent manner, on SLE survival. These results suggest that the use of antimalarial treatment should be recommended for patients with lupus.

Authors+Show Affiliations

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20131238

Citation

Shinjo, Samuel K., et al. "Antimalarial Treatment May Have a Time-dependent Effect On Lupus Survival: Data From a Multinational Latin American Inception Cohort." Arthritis and Rheumatism, vol. 62, no. 3, 2010, pp. 855-62.
Shinjo SK, Bonfá E, Wojdyla D, et al. Antimalarial treatment may have a time-dependent effect on lupus survival: data from a multinational Latin American inception cohort. Arthritis Rheum. 2010;62(3):855-62.
Shinjo, S. K., Bonfá, E., Wojdyla, D., Borba, E. F., Ramirez, L. A., Scherbarth, H. R., ... Pons-Estel, B. A. (2010). Antimalarial treatment may have a time-dependent effect on lupus survival: data from a multinational Latin American inception cohort. Arthritis and Rheumatism, 62(3), pp. 855-62. doi:10.1002/art.27300.
Shinjo SK, et al. Antimalarial Treatment May Have a Time-dependent Effect On Lupus Survival: Data From a Multinational Latin American Inception Cohort. Arthritis Rheum. 2010;62(3):855-62. PubMed PMID: 20131238.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antimalarial treatment may have a time-dependent effect on lupus survival: data from a multinational Latin American inception cohort. AU - Shinjo,Samuel K, AU - Bonfá,Eloísa, AU - Wojdyla,Daniel, AU - Borba,Eduardo F, AU - Ramirez,Luis A, AU - Scherbarth,Hugo R, AU - Brenol,João C Tavares, AU - Chacón-Diaz,Rosa, AU - Neira,Oscar J, AU - Berbotto,Guillermo A, AU - De La Torre,Ignacio Garcia, AU - Acevedo-Vázquez,Eduardo M, AU - Massardo,Loreto, AU - Barile-Fabris,Leonor A, AU - Caeiro,Francisco, AU - Silveira,Luis H, AU - Sato,Emilia I, AU - Buliubasich,Sandra, AU - Alarcón,Graciela S, AU - Pons-Estel,Bernardo A, AU - ,, PY - 2010/2/5/entrez PY - 2010/2/5/pubmed PY - 2010/4/3/medline SP - 855 EP - 62 JF - Arthritis and rheumatism JO - Arthritis Rheum. VL - 62 IS - 3 N2 - OBJECTIVE: To evaluate the beneficial effect of antimalarial treatment on lupus survival in a large, multiethnic, international longitudinal inception cohort. METHODS: Socioeconomic and demographic characteristics, clinical manifestations, classification criteria, laboratory findings, and treatment variables were examined in patients with systemic lupus erythematosus (SLE) from the Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohort. The diagnosis of SLE, according to the American College of Rheumatology criteria, was assessed within 2 years of cohort entry. Cause of death was classified as active disease, infection, cardiovascular complications, thrombosis, malignancy, or other cause. Patients were subdivided by antimalarial use, grouped according to those who had received antimalarial drugs for at least 6 consecutive months (user) and those who had received antimalarial drugs for <6 consecutive months or who had never received antimalarial drugs (nonuser). RESULTS: Of the 1,480 patients included in the GLADEL cohort, 1,141 (77%) were considered antimalarial users, with a mean duration of drug exposure of 48.5 months (range 6-98 months). Death occurred in 89 patients (6.0%). A lower mortality rate was observed in antimalarial users compared with nonusers (4.4% versus 11.5%; P< 0.001). Seventy patients (6.1%) had received antimalarial drugs for 6-11 months, 146 (12.8%) for 1-2 years, and 925 (81.1%) for >2 years. Mortality rates among users by duration of antimalarial treatment (per 1,000 person-months of followup) were 3.85 (95% confidence interval [95% CI] 1.41-8.37), 2.7 (95% CI 1.41-4.76), and 0.54 (95% CI 0.37-0.77), respectively, while for nonusers, the mortality rate was 3.07 (95% CI 2.18-4.20) (P for trend < 0.001). After adjustment for potential confounders in a Cox regression model, antimalarial use was associated with a 38% reduction in the mortality rate (hazard ratio 0.62, 95% CI 0.39-0.99). CONCLUSION: Antimalarial drugs were shown to have a protective effect, possibly in a time-dependent manner, on SLE survival. These results suggest that the use of antimalarial treatment should be recommended for patients with lupus. SN - 1529-0131 UR - https://www.unboundmedicine.com/medline/citation/20131238/Antimalarial_treatment_may_have_a_time_dependent_effect_on_lupus_survival:_data_from_a_multinational_Latin_American_inception_cohort_ L2 - https://doi.org/10.1002/art.27300 DB - PRIME DP - Unbound Medicine ER -