Consistent Antimalarial Intake in First 5 Years of SLE Linked to Improved Prognosis

needle on paper that says lupus
needle on paper that says lupus
Investigators evaluated long-term outcomes with antimalarial use and organ damage, flares, disease activity, glucocorticoid use, and antimalarial associated retinopathy.

A more consistent intake of antimalarial agents over the first 5 years of disease diagnosis among patients with systemic lupus erythematosus (SLE) is associated with improved outcomes, according to the results of a recent longitudinal Canadian cohort study published in The Journal of Rheumatology.

The investigators of the current study sought to examine whether more consistent use of antimalarial therapy among individuals with SLE is linked to better prognosis. Inception patients with SLE and a minimum of 5 years of follow-up were identified. The participants were divided into 3 groups, and during the first 5 years of follow-up, (group A) took antimalarial therapy >60% of the time, (group B) took antimalarial agents <60% of the time, and (group C) did not receive any antimalarial treatment.

During follow-up, 6 outcomes were evaluated: (1) organ damage (assessed yearly) by means of increase in Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI); (2) flares (assessed at each visit), using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and defined as any new clinical feature of the SLEDAI-2K since the previous assessment; (3) achievement of low disease activity at year 5; (4) adjusted mean SLEDAI-2K over 5 years; (5) cumulative doses of glucocorticosteroids; and (6) antimalarial treatment-related retinal toxicity. Univariate and multivariate regression analyses were performed to identify the effect of duration of antimalarial therapy on the 6 outcomes.

A total of 459 patients were identified: 236 (51.4%) in group A, 88 (19.2%) in group B, and 135 (29.4%) in group C. Changes in SDI (P =.003), flares (P =.04), and steroid use (P< .001) were all significantly lower among patients in group A, in which low disease activity was achieved significantly more often (P =.03). Moreover, participants in group A had a significantly lower risk for increasing SDI (P =.02) and were significantly more likely to achieve low disease activity at 5 years (P =.0009) compared with those in group C. Over the 5 years of follow-up, participants receiving antimalarial therapy reported a significantly lower use of glucocorticosteroids (P <.0001). Only 1 patient in group A and 1 patient in group B reported antimalarial treatment-related retinal toxicity.

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The investigators concluded that more consistent use of an antimalarial agents over the first 5 years of developing SLE (ie, >60% of the time) is associated with improved prognosis. These findings underscore the value of consistency in intake and use of antimalarial drugs in the early stages of SLE for the prevention of adverse long-term outcomes.

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Pakchotanon R, Gladman DD, Su J, Urowitz MB. More consistent antimalarial intake in first 5 years of disease is associated with better prognosis in patients with systemic lupus erythematosus [published online November 15, 2017]. J Rheumatol. doi:10.3899/jrheum.170645.