Systemic Lupus Erythematosus

Can a DMARD Decrease Mortality in SLE?

Patients with systemic lupus erythematosus (SLE) taking hydroxychloroquine (HCQ) treatment have a lower mortality rate compared with patients who are not taking the medication, according to results from a prospective study.


Although HCQ can reduce action in SLE, it is unknown whether it has a protective effect on survival in this patient population in Asia.



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For this study, the researchers evaluated data on 12,443 individuals from the Taiwan National Health Insurance Research Database and categorized them into HCQ and control cohorts based on whether they received HCQ treatment within 1 year after SLE diagnosis.


A total of 2287 patients in each group were included in the analysis after propensity score matching.


To examine the relationship between survival and HCQ adherence, a subgroup analysis was also performed. Patients with SLE were categorized based on medication possession ratio (MPR) in the first year; the cohorts were nonusers, MPR less than 40%, MPR between 40 and 80%, and MPR greater than 80%.


Mortality 1 year after study inclusion served as the primary outcome. The mean follow-up was 7.6 years.


Among patients in the HCQ group, a total of 169 events occurred compared with 248 events in the control group. The risk of mortality in the HCQ group was lower than that in the control group, with a hazard ratio of 0.68.


The subgroup analysis indicated an association between survival protective effect and HCQ adherence.


 “Patients with SLE who received HCQ had lower mortality rates due to any cause than those who did not,” the researchers concluded. “The survival benefit could be augmented by HCQ adherence.”


—Melinda Stevens



Hsu CY, Lin YS, Cheng TT, et al. Adherence to hydroxychloroquine improves long-term survival of patients with systemic lupus erythematosus. Rheumatology. 2018;57(10):1743-1751.