Hydroxychloroquine sulfate treatment is associated with later onset of systemic lupus erythematosus

• Published in: Lupus Vol. 16; no. 6; pp. 401 - 409
• Main Authors: James, JA, Kim-Howard, XR, Bruner, BF, Jonsson, MK, McClain, MT, Arbuckle, MR, Walker, C., Dennis, GJ, Merrill, JT, Harley, JB
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-01-2007; Sage Publications Ltd
• Subjects: Adult; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antibody Specificity; Arthritis; Autoantibodies - blood; Autoantibodies - immunology; Autoimmune diseases; Disease Progression; Glucocorticoids - therapeutic use; Health care access; Humans; Hydroxychloroquine - therapeutic use; Immunology; Lupus; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - physiopathology; Lupus Erythematosus, Systemic - prevention & control; Medical research; Middle Aged; Military Personnel; Patients; Prednisone - therapeutic use; Retrospective Studies; Rheumatology; Time Factors; United States > US; Oklahoma; systemic lupus erythematosus; hydroxychloroquine; SLE; therapy
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203307078579

Systemic lupus erythematosus (SLE) is a clinically diverse, complex autoimmune disease which may present with coincident onset of many criteria or slow, gradual symptom accrual. Early intervention has been postulated to delay or prevent the development of more serious sequelae. One option for treatment in this setting is hydroxychloroquine. Using 130 US military personnel who later met ACR SLE criteria, a retrospective study of onset, development and progression of SLE with and without pre-classification hydroxychloroquine (n = 26) use was performed. Patients treated with hydroxychloroquine prior to diagnosis had a longer (Wilcoxon signed rank test, P = 0.018) time between the onset of the first clinical symptom and SLE classification (median: 1.08 versus 0.29 years). Patients treated with prednisone before diagnosis also more slowly satisfied the classification criteria (Wilcoxon signed rank test, P = 0.011). The difference in median times between patients who received NSAIDs before diagnosis, as opposed to those who did not, was not different (P = 0.19). Patients treated with hydroxychloroquine also had a lower rate of autoantibody accumulation and a decreased number of autoantibody specificities at and after diagnosis. These findings are consistent with early hydroxychloroquine use being associated with delayed SLE onset. A prospective, blinded trial testing the capacity of hydroxychloroquine to delay or prevent SLE in high risk populations is warranted. Lupus (2007) 16, 401—409.