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Title: Antimalarial Treatment May Have a Time-Dependent Effect on Lupus Survival
Authors: Shinjo, Samuel Katsuyuki [UNIFESP]
Bonfa, Eloisa
Wojdyla, Daniel
Borba, Eduardo F.
Ramirez, Luis A.
Scherbarth, Hugo R.
Tavares Brenol, Joao C.
Chacon-Diaz, Rosa
Neira, Oscar J.
Berbotto, Guillermo A.
Garcia de La Torre, Ignacio
Acevedo-Vazquez, Eduardo M.
Massardo, Loreto
Barile-Fabris, Leonor A.
Caeiro, Francisco
Silveira, Luis H.
Sato, Emilia Inoue [UNIFESP]
Buliubasich, Sandra
Alarcon, Graciela S.
Pons-Estel, Bernardo A.
Grp Latino Amer Estudio Lupus Erit
Hosp Prov Rosario
Universidade de São Paulo (USP)
Univ Nacl Rosario
Univ Antioquia
Hosp Univ San Vicente de Paul
Hosp Interzonal Gen Agudos Dr Oscar Alende
Hosp Clin Porto Alegre
Univ Fed Rio Grande do Sul
Hosp Univ Caracas
Hosp Salvador
Univ Chile
Hosp Escuela Eva Peron
Hosp Gen Occidente Secretaria Salud
Hosp Nacl Guillermo Almenara Irigoyen
Pontificia Univ Catolica Chile
Hosp Especialidades Ctr Med Nacl Siglo XXI
Hosp Privado
Inst Nacl Cardiol Ignacio Chavez
Universidade Federal de São Paulo (UNIFESP)
Hosp Nacl Clin
Univ Alabama
Issue Date: 1-Mar-2010
Publisher: Wiley-Blackwell
Citation: Arthritis and Rheumatism. Hoboken: Wiley-liss, v. 62, n. 3, p. 855-862, 2010.
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.
ISSN: 0004-3591
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