Hydroxychloroquine and Risk of Thrombosis in Patients with Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis

Authors : Sankhyan P, Boonpheng B, Cook CT

Background/Purpose:

Over the course of the past few years hydroxychloroquine (HCQ) has been demonstrated to have a significant role in the symptom management of systemic lupus erythematosus (SLE) especially in milder forms of the disease. Several studies have also shown its benefit in prevention of thrombosis in SLE patients, yet the evidence remains unclear. We undertook this meta-analysis to assess the risk of vascular thrombosis on SLE patients on hydroxychloroquine.

Methods:

A systematic review was performed on the studies obtained from the databases of MEDLINE, EMBASE and Cochrane, from inception through January 2018 to extract studies that demonstrated an odds ratio of thrombosis in SLE patients (with or without anti-phospholipid antibodies) who were treated with HCQ compared to those not treated with HCQ. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird.

Results:

11 observational studies with a total of 14,066 SLE patients were enrolled. Compared with the patients not on HCQ, HCQ exposure was associated with significantly decreased risk of vascular thrombosis with a pooled odds ratio of 0.51 (95%CI 0.38-0.69, p<0.001). However, the result may be limited by publication bias as assessed by funnel plot.

Conclusion:

HCQ use is associated with 49% lower risk of vascular thrombosis compared to non-HCQ use in patients with SLE, as derived from our meta-analysis.