The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus (original) (raw)
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Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus
Lupus, 2006
Antimalarials have shown beneficial effects on systemic lupus erythematosus (SLE) activity. Our aim was to investigate whether antimalarials protect against thrombosis and influence survival in SLE patients. A prospective cohort including 232 patients with SLE were included in the study at the time of lupus diagnosis. End points were documented thrombosis and death due to any cause. A Cox regression-multiple-failure time survival analysis model was fitted to establish the effect of antimalarials on the development of thrombosis. Kaplan-Meier survival curves and propensity score adjusted-Cox regression analysis were performed to investigate the effect of antimalarials use on survival. Of our subjects, 204 patients (88%) were women. 230 patients (99%) were white. 150 patients (64%) had ever received antimalarials. Median time on antimalarials was 52 months (range three to 228 months). The Cox multiple-failure time survival analysis showed that taking antimalarials was protective again...
Frontiers in drug safety and regulation, 2023
Introduction: The antimalarials chloroquine and hydroxychloroquine have been used for several decades in treating malaria and some autoimmune diseases-mainly rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)-with excellent efficacy and safety. Due to the massive use of antimalarials worldwide for managing SARS-CoV-2/COVID-19 infection during the last 2 years and the consequent increase in cardiac arrhythmia, fear has risen about the safety of using antimalarials, especially for patients with increased cardiovascular risk. Objective: To describe a real-life experience about the safety of antimalarials in the setting of a single rheumatological center in Colombia. Methods: This is a cross sectional study that includes patients diagnosed with RA and treated with antimalarials between 2020 and 2021. Clinical follow-up information was gathered from the medical records, and all reported adverse events were described. Results: A total of 957 patients were included, primarily women (79.2%). The most frequent comorbidities were hypertension and osteoporosis. Chloroquine use was more frequent than hydroxychloroquine (86.4% vs. 13.6%). During the observation period, 243 (25.4%) patients presented at least one adverse event, 72 (29.6%) had retinal toxicity, 85 (35%) dermatological events, and 81 (33.3%) gastrointestinal intolerance. Other adverse events reported less frequently (15.2%) included headache, dizziness, lipothymia, and elevated transaminases. There were no reports of cardiovascular events from the period of antimalarial use to the date of data collection despite the high frequency of previous metabolic or cardiovascular disease in this cohort. Conclusion: This study reasserts the evidence of antimalarials safety profile for patients with rheumatological conditions such as RA. RA patients that were treated with antimalarials at doses recommended by the guidelines had no cardiovascular events.
Arthritis & Rheumatism, 2010
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, malig-nancy, 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).
Seminars in Arthritis and Rheumatism, 2022
Background/objectives: Factors associated with chronic heart failure (CHF) in patients with systemic lupus erythematosus (SLE) have received little attention. Recent data on the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection have cast doubt on its cardiac safety. The factors associated with CHF, including therapy with antimalarials, were analyzed in a large multicenter SLE cohort. Methods: Cross-sectional study including all patients with SLE (ACR-1997 criteria) included in the Spanish Society of Rheumatology Lupus Register (RELESSER), based on historically gathered data. Patients with CHF prior to diagnosis of SLE were excluded. A multivariable analysis exploring factors associated with CHF was conducted. Results: The study population comprised 117 patients with SLE (ACR-97 criteria) and CHF and 3,506 SLE controls. Ninety percent were women. Patients with CHF were older and presented greater SLE severity, organ damage, and mortality than those without CHF. The multivariable model revealed the factors associated with CHF to be ischemic heart disease (7.96 [4.01À15.48], p < 0.0001), cardiac arrhythmia (7.38 [4.00À13.42], p < 0.0001), pulmonary hypertension (3.71 [1.84À7.25], p < 0.0002), valvulopathy (6.33 [3.41À11.62], p < 0.0001), non-cardiovascular damage (1.29 [1.16À1.44], p < 0.000) and calcium/vitamin D treatment (5.29 [2.07À16.86], p = 0.0015). Female sex (0.46 [0.25À0.88], p = 0.0147) and antimalarials (0.28 [0.17À0.45], p < 0.000) proved to be protective factors. Conclusions: Patients with SLE and CHF experience more severe SLE. Treatment with antimalarials appears to confer a cardioprotective effect.
Clinical and experimental rheumatology
Antimalarials (AMs) have been demonstrated to reduce disease activity and prevent damage accrual in SLE. Recent guidelines advise prescribing AMs in all patients with SLE. We present data from the Amsterdam Lupus Cohort on use, reasons for non-use, and dosage related intolerance of AMs, as well as disease related variables associated with non-use. AM use was assessed in all our SLE patients included in a longitudinal cohort study. Demographic and disease characteristics were compared between users and non-users of AMs. Daily dosages of hydroxychloroquine (HCQ) according to lean body weight were calculated. Out of 190 SLE patients in the cohort, 139 (73.2%) were using AMs during their last visit, predominantly HCQ (136/139, 97.8%), while 92.1% (175/190) had ever used AMs. Daily dosage of HCQ was 400 mg in 115/136 (84.6%) patients. According to lean body weight, 119/136 (87.5%) had daily dosages of HCQ above the recommended 6.5 mg/kg. Patients did not use AMs (n=51) for the following ...
Long term effectiveness of antimalarial drugs in rheumatic diseases
Annals of the Rheumatic Diseases, 1998
Objective-The purpose of this study was to compare the long term eVectiveness between chloroquine (CQ) and hydroxychloroquine (HCQ). Methods-Medical charts of all patients seen by eight rheumatologists practising in two tertiary care centres and starting antimalarial treatment between January 1985 and December 1993 were reviewed. Patient characteristics, disease, and treatment information were collected. The main outcome measures were the cause of and the time to the discontinuation of antimalarial drugs resulting from all causes, principally toxicity or ineYcacy, or both. Bivariate analysis including t tests and 2 tests were used to assess diVerences between means and proportions respectively. Survival curves were evaluated using the Kaplan-Meier method. Multivariate analysis (Cox regression) was used to adjust for potential confounders. Results-After all medical records were reviewed, 1042 eligible cases were identified. From these, 940 (90%) had usable information and they represent the cohort. Five hundred and fifty eight had rheumatoid arthritis, 178 had systemic lupus erythematosus, 127 had palindromic arthritis, and 77 had other diagnoses. Fifty seven per cent of the patients received CQ and 43% HCQ. The propor-
Journal of Hospital Administration, 2014
Background: In a malaria-holoendemic region, concurrent malaria complicating heart failure (HF) occurs; with higher morbidity and increased adverse drug-drug interactions. Aim: To characterise malaria treatment and risk factors of cardio-toxicity among HF patients. Objectives: To characterise the use of anti-malaria agents (AMA), compare risk factors of torsades de pointes (TdP) amongst AMA-users and non-users, and to assess length of hospital stay. Methods: Admitted HF patients were retrospectively studied, and grouped on the basis of malaria treatment. TdP risk factors-advanced age, bradycardia, hypokalemia, and QTc prolongation were compared in the two groups. Results: The 160 HF patients (mean ejection fraction 39.6% ± 12.6%, mean age 54.9 ± 14.6 years) included 82 males (51.3%), with predominant non-ischemic HF. Malaria treatment occurred in 32.5% (52), though diagnosis was presumptive in 48 (92.3%). All (100%) malaria prescriptions were artemisinin-based, but monotherapeutic in 6 (11.4%). Partner-drugs included sulphadoxine-pyrimethamine (SP) 26 (50%), and lumefantrine 7 (13.5%). TdP risk-factors of age 65 years, prolonged QTc, hypokalemia, and bradycardia occurred in 43 (26.9%), 63 (39.4%), 48 (30%), and 8 (5.0%) respectively. Group 1 (AMA treated) and group 2 patients were comparable on all mean values of risk factors. Nevertheless, affected proportions were significantly different for hypokalemia (X 2 = 6.1), QTc prolongation (48.1% versus 35.2%, p < .05), and older age (38.5% versus, 21.3%, p < .05%). Conclusion: Though all HF patients similarly demonstrated risks of TdP, univariate analysis indicates a significantly higher proportion in malaria-treated patients; supporting further therapeutic caution in this patient subset.
Antimalarials may influence the risk of malignancy in systemic lupus erythematosus
Annals of The Rheumatic Diseases, 2007
Background: Recent studies suggest that antimalarials have antineoplastic properties. Objective: To investigate whether antimalarials decrease the risk of cancer in systemic lupus erythematosus (SLE). Methods: An observational prospective cohort study was carried out. 235 patients were included in the study at the time of diagnosis (American College of Rheumatology criteria). The end point was the diagnosis of cancer. Kaplan-Meier cancer-free survival curves for patients treated and not treated with antimalarials were compared. A Cox proportional hazards model was fitted, with cancer as the dependent variable. Age at diagnosis, gender, treatment with azathioprine, cyclophosphamide and methotrexate, smoking, Systemic Lupus International Collaborating Clinics (SLICC) Damage Index 6 months after diagnosis, year of diagnosis and treatment with antimalarials were entered as independent variables. Results: 209 (89%) patients were women. 233 (99%) patients were white. Mean (SD) age at diagnosis was 37 (16) years. Median (range) follow-up was 10 (1-31) years. 156 (66%) patients had ever received antimalarials. 2/156 (1.3%) evertreated patients compared with 11/79 (13%) never-treated patients had cancer (p,0.001). Cumulative cancer-free survival in treated and not treated patients was 0.98 and 0.73, respectively (p,0.001). Adjusted hazard ratio for cancer among malaria drug users compared with non-users was 0.15 (95% CI 0.02 to 0.99).