Treatment Combination Lowers Risk of CV Events in Lupus Patients

Results of a recent study showed that systemic lupus erythematosus (SLE) patients treated with aspirin and more than 600 g hydroxychloroquine (HCQ) have a decreased risk of cardiovascular (CV) events.

Previous research has shown that SLE is associated with an increased risk of CV disease. Treating SLE patients for CV risk with thromboprophylaxis with low-dose aspirin and HCQ has shown promise in the past.

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In their recent study, the researchers evaluated 189 patients with SLE at baseline and over a median follow-up period of 13 years. All patients included in the study satisfied the 1997 American College of Rheumatology and/or 2012 Systemic Lupus Collaborating Clinics classification criteria for SLE, and had not experienced any CV events.

Over the course of the study, the researchers recorded any occurrences of thrombotic events and any use of aspirin and HCQ cumulative dosages (c-HCQ). Kaplan-Meier analysis was conducted to calculate the dose of c-HCQ associated with a lower incidence of CV events. Factors associated with a first CV event were identified using Cox regression analysis.

Results indicated that 10 CV events occurred over the course of follow-up. Kaplan-Meier analysis demonstrated that rates of CV-event–free cases were higher among aspirin-treated patients receiving more than 600 g c-HCQ. However, patients receiving aspirin alone, or with a c-HCQ dose lower than 600 g, demonstrated higher rates of CV events.

Additionally, the researchers found via multivariate analysis that antimalarials plus aspirin protected against thrombosis, whereas antiphospholipid antibodies and hypertension increased participants’ risk of a first CV event.

“Our results suggest that prolonged use of HCQ plus [low-dose aspirin] is thromboprotective in SLE and provides additional evidence for its continued use in patients with SLE,” the researchers concluded.

—Christina Vogt


Fasano S, Pierro L, Pantano I, Iudici M, Valentini G. Longterm hydroxychloroquine therapy and low-dose aspirin may have an additive effectiveness in the primary prevention of cardiovascular events in patients with systemic lupus erythematosus. J Rheumatol. 2017;44(7):1032-1038. doi:10.3899/jrheum.161351.