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Abstract Number: 2569

Hydroxychloroquine Reduces Thrombosis in Systemic Lupus Erythematosus, Particularly in Antiphospholipid Positive Patients

Genevieve Law1, Laurence S. Magder2, Hong Fang3 and Michelle Petri3, 1Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada, 2Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, 3Johns Hopkins University School of Medicine, Baltimore, MD

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Hydroxychloroquine, systemic lupus erythematosus (SLE) and thrombosis

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Session Information

Session Title: ACR/REF Edmond L. Dubois, MD Memorial Lectureship: Hydroxychloroquine Reduces Thrombosis in Systemic Lupus Erythematosus, Particularly in Antiphospholipid Positive Patients

Session Type: Abstract Submissions (ACR)

Background/Purpose: Past studies, mostly cross-sectional, have found a reduction in thrombosis in systemic lupus erythematosus (SLE) patients taking hydroxychloroquine (HCQ). We examined the relationship between hydroxychloroquine and other medications with thrombosis in a large prospective SLE cohort.

Methods: We studied 1795 SLE patients (56% Caucasian, 37% African American, 93.3% female, mean age 37.0 ±12.5) with no previous thrombosis prior to entry in the cohort. The primary outcome was first thrombotic event (arterial or venous). Univariate analysis and multivariable modeling were used to examine associations between prednisone, hydroxycholoquine, and NSAID use with the risk of thrombosis.

Results:

A total of 193 thrombotic events were observed over 10,508 person-years of follow-up (rate 18.4/1000 person-years). In the multivariable model controlling for age, traditional cardiovascular risk factors, and SLE disease activity, significant predictors for thrombosis included current prednisone dose (>20 mg/day, HR 4.4, p<0.0001) and Aspirin use (HR 1.8, p=0.0026). Hydroxychloroquine use remained protective for thrombosis (HR 0.6, p=0.0075). Subgroup analysis revealed that the protective effect of hydroxychloroquine was stronger in antiphospholipid antibody positive patients (HR 0.6, p=0.0090) than among antiphospholipid antibody negative patients (HR 0.8, p=0.57).

 

Subgroup

Thrombotic events

Rate of events/ 1000 person-yrs

Rate Ratios

(95% CI)

P-value

Current Prednisone

 

None

52

10.6

1.0 (Ref. Gp)

 

1-9 mg/d

40

16.4

1.6 (1.1-2.4)

0.025

10-19 mg/d

49

34.3

3.3 (2.2-4.8)

<0.0001

20+ mg/d

43

71.8

6.5(4.3-9.8)

<0.0001

Cummulative Prednisone dose

 

None

29

13.1

1.0 (Ref. Gp)

 

<1 yr (10 mg/d)

37

23.8

1.6 (1.0-2.6)

0.075

1-3 yrs (10 mg/d)

30

19.0

1.8 (1.1-3.1)

0.026

3-10 yrs (10 mg/d)

45

25.5

3.0 (1.8-5.2)

<0.0001

>10 yrs (10 mg/d)

9

24.3

3.7 (1.5-9.4)

0.0056

Current HCQ

No

95

29.0

1.0 (Ref. Gp)

 

Yes

90

14.6

0.5 (0.4-0.7)

<0.0001

HCQ use

 

Never

57

32.2

1.0 (Ref. Gp)

 

Past (not current)

27

27.6

0.9 (0.6-1.5)

0.81

<6 consecutive mo

16

20.0

0.6 (0.3-1.0)

0.056

 >6 consecutive mo

64

13.8

0.5 (0.3-0.7)

0.0003

NSAID use

No

146

21.6

1.0 (Ref. Gp)

 

Yes

37

13.9

0.6 (0.4-0.9)

0.017

Aspirin use

 

No

137

17.9

1.0 (Ref. Gp)

 

Yes

49

28.0

1.6 (1.2-2.3)

0.0038

Conclusion: Current prednisone dose was found to be a significant independant predictor of thrombosis in SLE, after adjustment for disease activity. Current hydroxychloroquine use decreased the risk of thrombosis in this prospective cohort, particularly in those with positive antiphospholipid antibodies. Aspirin use was not protective, likely due to the bias of indication.


Disclosure:

G. Law,
None;

L. S. Magder,
None;

H. Fang,
None;

M. Petri,
None.

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