ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 0343

Severe Non-adherence to Hydroxychloroquine Is Associated with Flares, Early Damage, and Mortality in Systemic Lupus Erythematosus: Data from 660 Patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort

Yann Nguyen1, Benoît BLanchet2, Murray Urowitz3, John Hanly4, Caroline Gordon5, Sang-Cheol Bae6, Juanita Romero-Diaz7, Jorge Sanchez-Guerrero8, Ann E Clarke9, Sasha Bernatsky10, Daniel Wallace11, David Isenberg12, Anisur Rahman13, Joan Merrill14, Paul R Fortin15, Dafna Gladman16, Ian N. Bruce17, Michelle Petri18, Ellen M. Ginzler19, Mary Anne Dooley20, Rosalind Ramsey-Goldman21, Susan Manzi22, Andreas Jönsen23, Graciela Alarcón24, Ronald van Vollenhoven25, Cynthia Aranow26, Veronique Le Guern27, Meggan Mackay26, Guillermo Ruiz-Irastorza28, S. Sam Lim29, Murat Inanc30, Kenneth C Kalunian31, Soren Jacobsen32, Christine Peschken33, Diane Kamen34, Anca Askanase35, Jill Buyon36 and Nathalie Costedoat-Chalumeau37, 1AP-HP.Centre Universit Paris Cit Hôpital Cochin, Montmorency, France, 2Biologie du médicament-Toxicologie, AP-HP Centre – Hôpital Cochin, Université Paris Cité, Paris, France, Paris, 3University of Toronto, University Health Network, Schroeder Arthritis Institute, Toronto, ON, Canada, 4Division of Rheumatology, Queen Elizabeth II Health Sciences Center (Nova Scotia Rehabilitation Site) and Dalhousie University, Halifax, NS, Canada, 5Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom, 6Hanyang University Medical Center, Seoul, Republic of Korea, 7Instituto Nacional de Ciencias Medicas y Nutricion SZ, Ciudad de México, Mexico, 8Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada, 9University of Calgary, Division of Rheumatology, Cumming School of Medicine, Calgary, AB, Canada, 10Research Institute of the McGill University Health Centre, Montréal, QC, Canada, 11Cedars-Sinai Medical Center, Los Angeles, CA, 12University College London, London, United Kingdom, 13Centre for Rheumatology, Department of Medicine, University College London, London, United Kingdom, 14Oklahoma Medical Research Foundation, Oklahoma City, OK, 15Centre ARThrite - CHU de Québec - Université Laval, Québec, QC, Canada, 16Toronto Western Hospital, Schroeder Arthritis Institute, Toronto, ON, Canada, 17Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom, 18Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD, 19SUNY Downstate Health Sciences University, Department of Medicine, Brooklyn, NY, 20Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, 21Northwestern University Feinberg School of Medicine, Chicago, USA, Chicago, IL, 22Allegheny Health Network, Lupus Center of Excellence, Wexford, PA, 23Lund University, Lund, Sweden, 24The University of Alabama at Birmingham, Oakland, 25Amsterdam University Medical Centers, Amsterdam, Netherlands, 26Feinstein Institutes for Medical Research, Manhasset, NY, 27Hôpital Cochin, Paris, France, 28Autoimmune Diseases Research Unit, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Barakaldo, Spain, 29Emory University, Atlanta, GA, 30Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istambul, Turkey, 31University of California San Diego School of Medicine, La Jolla, 32Rigshospitalet, Copenhagen, Denmark, 33University of Manitoba, Winnipeg, MB, Canada, 34Medical University of South Carolina, Charleston, SC, 35Columbia University Medical Center, New York, NY, 36NYU Grossman School of Medicine, New York, NY, 37Inserm DR Paris 5, Paris, France

Meeting: ACR Convergence 2022

Keywords: Damage Index, Systemic lupus erythematosus (SLE)

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Date: Saturday, November 12, 2022

Title: SLE – Treatment Poster I

Session Type: Poster Session A

Session Time: 1:00PM-3:00PM

Background/Purpose: The efficacy of antimalarials, especially hydroxychloroquine (HCQ), in preventing flares of systemic lupus erythematosus (SLE) is well demonstrated, but its effectiveness is impaired by non-adherence to treatment, reported to vary between 3% and 85%. We aimed to assess the associations of baseline severe non-adherence to HCQ, objectively assessed by HCQ serum levels, and risks of SLE flares, damage, and mortality over 5 years of follow-up.

Methods: The SLICC Inception Cohort is a multicentric prospective study of SLE patients from 31 centers in 11 countries. Patients were enrolled within 15 months of recognition of SLE (1997 ACR classification criteria). Serum HCQ levels of patients with HCQ prescription for at least 3 months, sampled at enrollment (or, if unavailable, during the first-year follow-up visits), were centrally measured. Severe non-adherence was defined by a serum HCQ level < 106 ng/mL for a daily prescribed HCQ dose of 400 mg, and < 53 ng/mL for a daily HCQ dose of 200 mg, respectively (1). SLE flare was defined by the occurrence of one of the following events within the first year following serum collection: (a) increase of at least four point in the SLEDAI-2K; (b) new start in prednisone (oral or pulse) or immunosuppressive agent; (c) a new renal involvement (active nephritis, nephrotic syndrome). Association between severe non-adherence and SLE flare was assessed with logistic regression models, further adjusted on potential confounders. Damage was assessed by the time until an increase ≥1 in the SLICC damage index (SDI), within the 5 years following HCQ measurement. Associations between severe non-adherence and either damage or mortality (from all cause) within 5 years following HCQ measurement were assessed with Cox proportional hazard models, adjusted on sex, education, and potential confounders.

Results: Of 1849 cohort subjects, 660 patients (88% women) were included. Median [interquartile range] serum HCQ level was 388 ng/mL (244-566) and 48 patients (7.3%) had severe HCQ non-adherence. No factors were clearly associated with severe non-adherence. A SLE flare occurred in 191 (28.9%) patients within the first year (28 [58.3%] non-adherent patients versus 163 [26.6%] other patients). In multivariate analysis, severe nonadherence was independently associated with the risk of flare (OR= 3.32; 95% CI 1.78-6.28).

Within five years, 167 patients (25.3%) had ≥1 point increase of SDI. Severe on-adherence was associated with an increase in the SDI within each of the first 3 years (HR 1.92 at 3 years; 95% CI 1.05–3.50).

Eleven patients died within 5 years, including 3 with severe non-adherence (unadjusted HR 5.41; 95% CI 1.43–20.39).

Conclusion: In this large multicentric international prospective cohort, severe non-adherence was independently associated with the risk of SLE flare in the following year, with early damage, and 5-year mortality. As severe non-adherence is often unknown by the physician and since no predictive clinical or biological factors were identified, our results suggest the benefits of testing to detect severe non-adherence, to identify the patients at risk.

Supporting image 1

Figure 1. Kaplan Meier curves for the risk of damage, defined by a ≥1-point increase of SLICC/ACR damage index, according to severe non-adherence. Severe non-adherence was associated with the risk of SDI worsening at 1 (adjusted HR 4.26; 95% CI 1.40–13), 2 (adjusted HR 3.54; 95% CI 1.83–6.86) and 3 years after the HCQ measurement (adjusted HR 1.92; 95% CI 1.05–3.50), with a non-significant trend at 5 years (adjusted HR 1.47; 95% CI 0.86–2.49). *P<0.05; **P<0.01; NS: non-significant. Following variables were included in the multivariate models: age, black race, education level (post-secondary; ≤High school), SLEDAI_2000, azathioprine, and severe HCQ non-adherence.


Disclosures: Y. Nguyen, None; B. BLanchet, None; M. Urowitz, None; J. Hanly, None; C. Gordon, UCB, Amgen, Astra-Zeneca, AbbVie, Sanofi, MGP; S. Bae, None; J. Romero-Diaz, Biogen; J. Sanchez-Guerrero, None; A. Clarke, AstraZeneca, Bristol Myers Squibb (BMS), GlaxoSmithKline (GSK); S. Bernatsky, None; D. Wallace, None; D. Isenberg, Merck/MSD, astra zeneca, Eli Lilly, Servier, Amgen; A. Rahman, None; J. Merrill, UCB, GlaxoSmithKline, AbbVie, EMD Serono, Remegen, Celgene/Bristol Myers Squibb, AstraZeneca, Amgen, Janssen, Lilly, Genentech, Aurinia, Astellas, Alexion, Sanofi, Zenas, Proventio; P. Fortin, AstraZeneca, GlaxoSmithKlein(GSK); D. Gladman, AbbVie, Amgen, Eli Lilly, Janssen, Gilead, Novartis, Pfizer, Bristol-Myers Squibb(BMS), Galapagos, UCB Pharma, Celgene; I. Bruce, AstraZeneca, Bristol-Myers Squibb(BMS), Eli Lilly, Aurinia, Janssen, GlaxoSmithKlein(GSK); M. Petri, Exagen, AstraZeneca, Alexion, Amgen, AnaptysBio, Argenx, Aurinia, Biogen, Caribou Biosciences, CVS Health, EMD Serono, Eli Lilly, Emergent Biosolutions, GlaxoSmithKline (GSK), IQVIA, Janssen, Kira Pharmaceuticals, MedShr, Sanofi, SinoMab, Thermofisher, BPR Scientific Advisory Committee; E. Ginzler, Aurinia Pharma; M. Dooley, None; R. Ramsey-Goldman, None; S. Manzi, AstraZeneca, GlaxoSmithKline (GSK), Exagen Diagnostics Inc, AbbVie, HGS, Cugene, Lilly, UCB Advisory Board, Lupus Foundation of America; A. Jönsen, None; G. Alarcón, None; R. van Vollenhoven, Bristol Myers Squibb (BMS), GlaxoSmithKline (GSK), UCB, Merck/MSD, Pfizer, Roche, AbbVie, AstraZeneca, Biogen, Galapagos, Janssen, Miltenyi, R-Pharma; C. Aranow, None; V. Le Guern, None; M. Mackay, None; G. Ruiz-Irastorza, None; S. Lim, None; M. Inanc, None; K. Kalunian, None; S. Jacobsen, None; C. Peschken, None; D. Kamen, None; A. Askanase, AstraZeneca, GlaxoSmithKlein(GSK), Aurinia, Amgen, Pfizer, Idorsia, Eli Lilly, UCB, AbbVie/Abbott, Janssen, Bristol-Myers Squibb(BMS); J. Buyon, None; N. Costedoat-Chalumeau, UCB, Roche.

To cite this abstract in AMA style:

Nguyen Y, BLanchet B, Urowitz M, Hanly J, Gordon C, Bae S, Romero-Diaz J, Sanchez-Guerrero J, Clarke A, Bernatsky S, Wallace D, Isenberg D, Rahman A, Merrill J, Fortin P, Gladman D, Bruce I, Petri M, Ginzler E, Dooley M, Ramsey-Goldman R, Manzi S, Jönsen A, Alarcón G, van Vollenhoven R, Aranow C, Le Guern V, Mackay M, Ruiz-Irastorza G, Lim S, Inanc M, Kalunian K, Jacobsen S, Peschken C, Kamen D, Askanase A, Buyon J, Costedoat-Chalumeau N. Severe Non-adherence to Hydroxychloroquine Is Associated with Flares, Early Damage, and Mortality in Systemic Lupus Erythematosus: Data from 660 Patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/severe-non-adherence-to-hydroxychloroquine-is-associated-with-flares-early-damage-and-mortality-in-systemic-lupus-erythematosus-data-from-660-patients-from-the-systemic-lupus-international-collabor/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to ACR Convergence 2022

ACR Meeting Abstracts - https://acrabstracts.org/abstract/severe-non-adherence-to-hydroxychloroquine-is-associated-with-flares-early-damage-and-mortality-in-systemic-lupus-erythematosus-data-from-660-patients-from-the-systemic-lupus-international-collabor/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology