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Abstract Number: 743

Long-Term Hydroxychloroquine Therapy and Low-Dose Aspirin May Have an Additive Effectiveness in the Primary Prevention of Cardiovascular Events in Patients with Systemic Lupus Erythematosus

Serena Fasano1, Michele Iudici2, Ilenia Pantano3, Luciana Pierro3 and Gabriele Valentini4, 1Internal and Experimental Medicine Naples, Italy, Rheumatology Unit, Second University of Naples, Naples, Italy, 2National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, 3Rheumatology Unit, Second University of Naples, Naples, Italy, 4Internal and Experimental Medicine, Rheumatology Unit, Second University of Naples, Naples, Italy

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: aspirin, Cardiovascular disease, hydroxychloroquine and prevention, Lupus

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Session Information

Date: Sunday, November 13, 2016

Session Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster I: Clinical Trial Design and Current Therapies

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Hydroxychloroquine (HCQ) is a mainstay of treatment in patients with SLE. It has been demonstrated to reduce disease activity and prevent damage accrual and suggested to give benefits on thrombosis prevention [1-2]. We have recently pointed out a role of low dose aspirin (ASA) in the primary prophylaxis of cardiovascular disease (CVD) in SLE [3]. In that study, we did not detect any time and dose-independent protective effect of antimalarials. The present analysis was performed to investigate the role of distinct HCQ cumulative dosages and treatment durations.

Methods: patients consecutively admitted to a tertiary center, who, at baseline, satisfied 1992 ACR and/or 2012 SLICC classification criteria for SLE and had not experienced any CV event, were enrolled. ASA treatment, daily and cumulative dosages of HCQ and treatment duration were noticed. A number of attempts were performed to identify the dosage of HCQ and its treatment duration associated with a lower incidence of CV events as assessed by evaluating CV events free survival by Kaplan-Meier curves.

Results: 189 consecutive SLE patients were enrolled and followed up for a median of 13 years (range 1-15 years). Out of them, 80.9% (153/189) had ever used HCQ, with a median treatment duration of 4 years (range 1-15). 80/153 (52.2%) had a treatment duration >5 years and 83/153 (54.2%) patients had cumulative HCQ dosages>600g. Out of the 189 patients, 31(16.4%) were treated with ASA alone and 134 (70.8%) were treated with both ASA and HCQ. During follow-up, there were 10 CV events (1 stroke, 5 TIA, and 4 MI). CV event-free rate was higher in patients treated with HCQ for more than 5 years (log-rank test χ2 = 6.10; p= 0.01) and in patients with a cumulative HCQ dosage >600g (log-rank test χ2 = 6.45; p= 0.01) [figure1-2]. Comparing the 76 patients treated by ASA and HCQ with a cumulative dosage>600g and a treatment duration >5 years with 87 the patients treated by ASA and either no HCQ or HCQ of a dosage<600g and a treatment duration <5 years, a nearly significant difference was detected in CV events free rates (p=0.069) [figure 3].

Conclusion: Antimalarials, when administered for more than 5 years at a cumulative dosage>600g, may furtherly reduce the CV risk in SLE patients. Larger, prospective studies are needed to fully address this topic.


Disclosure: S. Fasano, None; M. Iudici, None; I. Pantano, None; L. Pierro, None; G. Valentini, None.

To cite this abstract in AMA style:

Fasano S, Iudici M, Pantano I, Pierro L, Valentini G. Long-Term Hydroxychloroquine Therapy and Low-Dose Aspirin May Have an Additive Effectiveness in the Primary Prevention of Cardiovascular Events in Patients with Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/long-term-hydroxychloroquine-therapy-and-low-dose-aspirin-may-have-an-additive-effectiveness-in-the-primary-prevention-of-cardiovascular-events-in-patients-with-systemic-lupus-erythematosus/. Accessed January 21, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-hydroxychloroquine-therapy-and-low-dose-aspirin-may-have-an-additive-effectiveness-in-the-primary-prevention-of-cardiovascular-events-in-patients-with-systemic-lupus-erythematosus/

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