Antimalarial Drugs May Reduce Polyautoimmunity in Systemic Lupus Erythematosus

Woman with systemic lupus erythematosus
Woman with systemic lupus erythematosus
Researchers evaluated the frequency of polyautoimmunity and its associated factors in a large retrospective cohort of patients with systemic lupus erythematosus.

Antimalarial drugs may have a protective effect against polyautoimmunity in patients with systemic lupus erythematosus (SLE), according to study results published in Rheumatology.

The study included patients from the Spanish Society of Rheumatology Lupus Registry (RELESSER) who fulfilled the criteria for SLE (n=3679). Researchers investigated the prevalence of polyautoimmunity in this population, which they defined as the co-occurrence of SLE and another autoimmune disease. Researchers also determined the presence of multiple autoimmune syndrome, secondary Sjogren syndrome (SS), secondary antiphospholipid syndrome (APS), and family history of autoimmune disease. Using multiple logistic regression analysis, the researchers explored potential risk factors for polyautoimmunity.

A total of 13.6% of patients (n=502) were indicated to have polyautoimmunity. The most common types of co-occurring autoimmune diseases were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%), and secondary APS (13.7%).

Results indicated that 10.2% of patients with polyautoimmunity had multiple autoimmune syndrome. Family history of autoimmune disease was present in 11.8% of polyautoimmunity cases.

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After performing multivariate analysis, the researchers found several factors associated with an increased risk for polyautoimmunity, including being women (odds ratio [OR], 1.72; 95% CI, 1.07-2.72), Raynaud phenomenon (OR, 1.63; 95% CI, 1.29-2.05), interstitial lung disease (OR, 3.35; 95% CI, 1.84-6.01), Jaccoud arthropathy (OR, 1.92; 95% CI, 1.40-2.63), anti-Ro/SSA and/or anti-La/SSB autoantibodies (OR, 2.03; 95% CI, 1.55-2.67), anti-RNP antibodies (OR, 1.48; 95% CI, 1.16-1.90), and methotrexate (OR, 1.67; 95% CI, 1.26-2.18).

However, 1 variable, antimalarial drugs, was found to be associated with a reduced risk for polyautoimmunity (OR, 0.50; 95% CI, 0.38-0.67).

Study limitations included the fact that the accuracy of serologic data may have been affected because there was no centralized laboratory and that most of the comorbid autoimmune diseases were not collected exhaustively or independently.

“While this finding has to be confirmed, the lower frequency of antimalarial drugs in patients with polyautoimmunity suggests that these agents could have a protective effect against polyautoimmunity,” the researchers wrote.

Disclosure: This clinical trial was supported by GlaxoSmithKline, Roche, Union Chimique Belge, Lilly, and Novartis. Please see the original reference for a full list of authors’ disclosures.


Mena-Vazquez N, Fernandez-Nebro A, Pego-Reigosa JM, et al. Hydroxychloroquine is associated with a lower risk of polyautoimmunity: data from the RELESSER Registry [published online December 6, 2019]. Rheumatology. doi:10.1093/rheumatology/kez562