Hydroxychloroquine Use Is Associated Independently with Improved Quality of Life in Systemic Lupus Erythematosus

Meenakshi Jolly¹, Winston Sequeira², Sarfraz Hasni³, Zulfiqar Ali⁴, Sergio Toloza⁵, Ana M. Bertoli⁶, Ivana Blazevic⁷, Luis M. Vila⁸, Ioana Moldovan⁹, Karina D Torralba¹⁰, Berna Goker¹¹, Josiane Bourré-Tessier¹², S. Navarra¹³, Daniel Wallace¹⁴, Michael H. Weisman¹⁵, Ann E. Clarke¹⁶ and Chi Chiu Mok¹⁷, ¹Rheumatology, Rush University Medical Center, Chicago, IL, ²Medicine/Rheumatology, Rush University, Chicago, IL, ³NIH, BETHESDA, MD, ⁴NIH, Bethesda, MD, ⁵Hospital San Juan Bautista, San Fernando del Valle de Catamarca, Argentina, ⁶Instituto Reumatológico Strusberg, Cordoba, Cordoba, Argentina, ⁷University of Buenos Aires, Buenos Aries, Argentina, ⁸Department of Medicine, Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, PR, ⁹Rheumatology, Beaver Medical Group, Redlands, CA, ¹⁰University of Southern California, LA, CA, ¹¹Department of Internal Medicine- Rheumatology, Gazi University School of Medicine, Ankara, Turkey, ¹²Department of Medicine, Division of Rheumatology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada, ¹³University of Santo Tomas Hospital, Manila, Philippines, ¹⁴UCLA, LA, CA, ¹⁵Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, ¹⁶Division of Rheumatology, University of Calgary, Calgary, AB, Canada, ¹⁷Medicine, Tuen Mun Hospital, Hong Kong, Hong Kong

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: hydroxychloroquine and quality of life, SLE

Session Information

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment: Treatment and Management Studies

Session Type: Abstract Submissions (ACR)

Background/Purpose: Hydroxychloroquine (HCQ) has been shown to be beneficial to patients with Systemic Lupus Erythematosus (SLE), however, its effects on the quality of life (QOL) of patients with SLE has not been evaluated. Interestingly, there is not a clear concordance between pharmacological amelioration of visceral organ damage in SLE and QOL, as reported by patients themselves. LupusPRO is a disease targeted QOL tool that is well validated in English and various other languages, and has two construct: health related quality of life (HRQOL) and non-HRQOL. Here, we test the hypothesis that treatment with HCQ has a beneficial effect on QOL as well as organ function in patients with SLE.

Methods: Cross sectional data from 1,037 SLE patients (USA, Canada, Argentina, Mexico, Philippines, Turkey, and China) was accumulated, after obtaining informed consent and IRB approval. Age, gender, LupusPRO scores, disease activity, and disease damage were analyzed. Disease activity was measured by SLEDAI (physician global assessment and Total), while damage was assessed using SLICC-ACR/SDI. We compared the QOL on the LupusPRO domains using nonparametric independent sample t tests, using two sided p values of ≤ 0.05 as significant. T tests were also used to compare disease activity and disease damage in patients where the data were available. Multivariate linear regression analysis for satisfaction with treatment domain of LupusPRO was performed as the dependent variable, and HCQ use, age, gender, disease activity (SLEDAI), damage (SLICC-ACR/SDI) and current steroid use as independent variables.

Results: 1,037 SLE patients (727 HCQ users and 310 non-HCQ users) data were analyzed. HCQ users and non-users were similar in age and gender (Mean age (SD) 40.1 (13.0 vs. 42.5 (12.9) yrs). SLICC-ACR/SDI was lower, while non-HRQOL was higher among HCQ users as compared to non-HCQ users (Table 1). Specifically non-HRQOL domain of satisfaction with treatment was significantly better among HCQ users than non-HCQ users. On multivariate analysis, HCQ use remained an independent predictor of satisfaction with treatment (non HRQOL LupusPRO domain), even after adjusting for age, gender, disease activity, damage and current steroid use.

Conclusion: Hydroxychloroquine use in SLE has clearly beneficial effects on QOL. This is in addition to the well-recognized ameliorative effects on cumulative damage. The QOL improvement appears to be related to non-HRQOL (satisfaction with treatment) independently. Longitudinal studies with disease targeted QOL tools with use of HCQ are indicated.

	HCQ (n=310)	No HCQ (n=727)	P value
Age (yrs) Mean (SD)	40.1 (13.0)	42.5 (12.9)	0.82
Gender (Female %)	93.6	94.2	0.75
SLEDAI (Mean, SD)	3.4, 4.3	3.5, 4.1	0.92
SLICC-ACR/SDI (Mean, SD)	0.7, 1.1	0.9, 1.3	0.003
LupusPRO HRQOL (Median, IQR)	77.5, 23.7	80.1, 22.7	0.14
LupusPRO non HRQOL (Median, IQR)	68.2, 27.5	65.9, 28.5	0.03
Satisfaction with Treatment (Median, IQR)	75.0,56.3	62.5. 62.5	<0.001
Multivariate Analysis for Satisfaction with Treatment non HRQOL LupusPRO domain HCQ use Age Gender Disease Activity (SLEDAI) Damage Index (SLICC-ACR/SDI) Current Steroid use	Β co-efficient 7.2 -0.2 -3.1 0.7 1.8 4.2	95% CI 2.7 to 11.7 -0.4 to -0.01 -11.8 to 5.7 0.2 to 1.2 -0.05 to 3.6 -0.2 to 8.6	P value 0.002 0.04 0.49 0.01 0.06 0.06

Disclosure:

M. Jolly,
None;

W. Sequeira,
None;

S. Hasni,
None;

Z. Ali,
None;

S. Toloza,
None;

A. M. Bertoli,
None;

I. Blazevic,
None;

L. M. Vila,
None;

I. Moldovan,
None;

K. D. Torralba,
None;

B. Goker,
None;

J. Bourré-Tessier,
None;

S. Navarra,

Pfizer,GSK,

D. Wallace,
None;

M. H. Weisman,
None;

A. E. Clarke,
None;

C. C. Mok,
None.

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