Effect of long-term hydroxychloroquine on vascular events in patients with systemic lupus erythematosus: a database prospective cohort study
The incidence of thromboembolism in patients with SLE is higher than that in the general population. HCQ, widely used to treat lupus, may have vascular protective effects. The aim of this study was to determine whether long-term HCQ exposure is associated with decreased thromboembolism risk in SLE....
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Veröffentlicht in: | Rheumatology (Oxford, England) England), 2017-12, Vol.56 (12), p.2212-2221 |
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creator | Hsu, Chung-Yuan Lin, Yu-Sheng Su, Yu-Jih Lin, Hsing-Fen Lin, Ming-Shyan Syu, Ya-Jhu Cheng, Tien-Tsai Yu, Shan-Fu Chen, Jia-Feng Chen, Tien-Hsing |
description | The incidence of thromboembolism in patients with SLE is higher than that in the general population. HCQ, widely used to treat lupus, may have vascular protective effects. The aim of this study was to determine whether long-term HCQ exposure is associated with decreased thromboembolism risk in SLE.
We designed a prospective cohort study within an SLE population based on the National Health Insurance Research Database in Taiwan. We divided participants into HCQ and control groups according to HCQ prescription during the first year. These groups were defined by medication possession ratio (MPR) ⩾80% and MPR = 0%, respectively. Patients with an MPR between 0 and 80% were excluded. The primary outcome was a composite vascular event, including acute coronary syndrome, ischaemic stroke, pulmonary embolism, deep vein thrombosis and peripheral arterial disease 1 year after inclusion. We excluded patients from the cohort if they had outcomes within the first year.
A total of 8397 patients were eligible for analysis. After propensity-score matching, we included 1946 patients in each group. During a mean follow-up of 7.4 years, the number of events was 139 in the HCQ group (7.1%) and 149 in the control group (7.7%). The risk of vascular events in the HCQ group was similar to that in the control group (hazard ratio = 0.91; 95% CI: 0.72, 1.15). Further subgroup analyses confirmed no statistically significant differences between the groups.
Long-term HCQ appears to have no vascular protective effect in patients with SLE. |
doi_str_mv | 10.1093/rheumatology/kex357 |
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We designed a prospective cohort study within an SLE population based on the National Health Insurance Research Database in Taiwan. We divided participants into HCQ and control groups according to HCQ prescription during the first year. These groups were defined by medication possession ratio (MPR) ⩾80% and MPR = 0%, respectively. Patients with an MPR between 0 and 80% were excluded. The primary outcome was a composite vascular event, including acute coronary syndrome, ischaemic stroke, pulmonary embolism, deep vein thrombosis and peripheral arterial disease 1 year after inclusion. We excluded patients from the cohort if they had outcomes within the first year.
A total of 8397 patients were eligible for analysis. After propensity-score matching, we included 1946 patients in each group. During a mean follow-up of 7.4 years, the number of events was 139 in the HCQ group (7.1%) and 149 in the control group (7.7%). The risk of vascular events in the HCQ group was similar to that in the control group (hazard ratio = 0.91; 95% CI: 0.72, 1.15). Further subgroup analyses confirmed no statistically significant differences between the groups.
Long-term HCQ appears to have no vascular protective effect in patients with SLE.</description><identifier>ISSN: 1462-0324</identifier><identifier>EISSN: 1462-0332</identifier><identifier>DOI: 10.1093/rheumatology/kex357</identifier><identifier>PMID: 29029334</identifier><language>eng</language><publisher>England</publisher><subject>Adolescent ; Adult ; Antirheumatic Agents - administration & dosage ; Antirheumatic Agents - adverse effects ; Databases, Factual ; Female ; Follow-Up Studies ; Humans ; Hydroxychloroquine - administration & dosage ; Hydroxychloroquine - adverse effects ; Incidence ; Lupus Erythematosus, Systemic - drug therapy ; Male ; Middle Aged ; Propensity Score ; Prospective Studies ; Taiwan ; Time ; Vascular Diseases - chemically induced ; Vascular Diseases - epidemiology ; Young Adult</subject><ispartof>Rheumatology (Oxford, England), 2017-12, Vol.56 (12), p.2212-2221</ispartof><rights>The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c350t-c538e5f0e611b347a82608abc7f0b51abdd167a75bfabf7e2746463e5432b9a23</citedby><cites>FETCH-LOGICAL-c350t-c538e5f0e611b347a82608abc7f0b51abdd167a75bfabf7e2746463e5432b9a23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29029334$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hsu, Chung-Yuan</creatorcontrib><creatorcontrib>Lin, Yu-Sheng</creatorcontrib><creatorcontrib>Su, Yu-Jih</creatorcontrib><creatorcontrib>Lin, Hsing-Fen</creatorcontrib><creatorcontrib>Lin, Ming-Shyan</creatorcontrib><creatorcontrib>Syu, Ya-Jhu</creatorcontrib><creatorcontrib>Cheng, Tien-Tsai</creatorcontrib><creatorcontrib>Yu, Shan-Fu</creatorcontrib><creatorcontrib>Chen, Jia-Feng</creatorcontrib><creatorcontrib>Chen, Tien-Hsing</creatorcontrib><title>Effect of long-term hydroxychloroquine on vascular events in patients with systemic lupus erythematosus: a database prospective cohort study</title><title>Rheumatology (Oxford, England)</title><addtitle>Rheumatology (Oxford)</addtitle><description>The incidence of thromboembolism in patients with SLE is higher than that in the general population. HCQ, widely used to treat lupus, may have vascular protective effects. The aim of this study was to determine whether long-term HCQ exposure is associated with decreased thromboembolism risk in SLE.
We designed a prospective cohort study within an SLE population based on the National Health Insurance Research Database in Taiwan. We divided participants into HCQ and control groups according to HCQ prescription during the first year. These groups were defined by medication possession ratio (MPR) ⩾80% and MPR = 0%, respectively. Patients with an MPR between 0 and 80% were excluded. The primary outcome was a composite vascular event, including acute coronary syndrome, ischaemic stroke, pulmonary embolism, deep vein thrombosis and peripheral arterial disease 1 year after inclusion. We excluded patients from the cohort if they had outcomes within the first year.
A total of 8397 patients were eligible for analysis. After propensity-score matching, we included 1946 patients in each group. During a mean follow-up of 7.4 years, the number of events was 139 in the HCQ group (7.1%) and 149 in the control group (7.7%). The risk of vascular events in the HCQ group was similar to that in the control group (hazard ratio = 0.91; 95% CI: 0.72, 1.15). Further subgroup analyses confirmed no statistically significant differences between the groups.
Long-term HCQ appears to have no vascular protective effect in patients with SLE.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Antirheumatic Agents - administration & dosage</subject><subject>Antirheumatic Agents - adverse effects</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hydroxychloroquine - administration & dosage</subject><subject>Hydroxychloroquine - adverse effects</subject><subject>Incidence</subject><subject>Lupus Erythematosus, Systemic - drug therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Propensity Score</subject><subject>Prospective Studies</subject><subject>Taiwan</subject><subject>Time</subject><subject>Vascular Diseases - chemically induced</subject><subject>Vascular Diseases - epidemiology</subject><subject>Young Adult</subject><issn>1462-0324</issn><issn>1462-0332</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNUU1v1TAQtBAVLQ9-ARLykUuoP-LkhRuqSotUiUt7jtbOugkkcfDar81_4Ef3PV6pOO0cdnZmZxj7IMVnKRp9HnvME6Qwhvv1_Bc-alO_YmeyrFQhtFavX7AqT9lbop9CCCP19g07VY1QjdblGftz6T26xIPnY5jvi4Rx4v3axfC4un4MMfzOw4w8zHwH5PIIkeMO50R8mPkCafiLH4bUc1op4TQ4PuYlE8e4ph4PDinTFw68gwQWCPkSAy171WGH3IU-xMQp5W59x048jITvn-eG3X27vL24Lm5-XH2_-HpTOG1EKpzRWzReYCWl1WUNW1WJLVhXe2GNBNt1sqqhNtaD9TWquqzKSqMptbINKL1hn453l8N7SKmdBnI4jjBjyNTKxshS1mYf0Ybp46rbe6aIvl3iMEFcWynaQw3t_zW0xxr2rI_PAtlO2L1w_uWunwBCAY1c</recordid><startdate>20171201</startdate><enddate>20171201</enddate><creator>Hsu, Chung-Yuan</creator><creator>Lin, Yu-Sheng</creator><creator>Su, Yu-Jih</creator><creator>Lin, Hsing-Fen</creator><creator>Lin, Ming-Shyan</creator><creator>Syu, Ya-Jhu</creator><creator>Cheng, Tien-Tsai</creator><creator>Yu, Shan-Fu</creator><creator>Chen, Jia-Feng</creator><creator>Chen, Tien-Hsing</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20171201</creationdate><title>Effect of long-term hydroxychloroquine on vascular events in patients with systemic lupus erythematosus: a database prospective cohort study</title><author>Hsu, Chung-Yuan ; Lin, Yu-Sheng ; Su, Yu-Jih ; Lin, Hsing-Fen ; Lin, Ming-Shyan ; Syu, Ya-Jhu ; Cheng, Tien-Tsai ; Yu, Shan-Fu ; Chen, Jia-Feng ; Chen, Tien-Hsing</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c350t-c538e5f0e611b347a82608abc7f0b51abdd167a75bfabf7e2746463e5432b9a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Antirheumatic Agents - administration & dosage</topic><topic>Antirheumatic Agents - adverse effects</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Hydroxychloroquine - administration & dosage</topic><topic>Hydroxychloroquine - adverse effects</topic><topic>Incidence</topic><topic>Lupus Erythematosus, Systemic - drug therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Propensity Score</topic><topic>Prospective Studies</topic><topic>Taiwan</topic><topic>Time</topic><topic>Vascular Diseases - chemically induced</topic><topic>Vascular Diseases - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hsu, Chung-Yuan</creatorcontrib><creatorcontrib>Lin, Yu-Sheng</creatorcontrib><creatorcontrib>Su, Yu-Jih</creatorcontrib><creatorcontrib>Lin, Hsing-Fen</creatorcontrib><creatorcontrib>Lin, Ming-Shyan</creatorcontrib><creatorcontrib>Syu, Ya-Jhu</creatorcontrib><creatorcontrib>Cheng, Tien-Tsai</creatorcontrib><creatorcontrib>Yu, Shan-Fu</creatorcontrib><creatorcontrib>Chen, Jia-Feng</creatorcontrib><creatorcontrib>Chen, Tien-Hsing</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Rheumatology (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hsu, Chung-Yuan</au><au>Lin, Yu-Sheng</au><au>Su, Yu-Jih</au><au>Lin, Hsing-Fen</au><au>Lin, Ming-Shyan</au><au>Syu, Ya-Jhu</au><au>Cheng, Tien-Tsai</au><au>Yu, Shan-Fu</au><au>Chen, Jia-Feng</au><au>Chen, Tien-Hsing</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of long-term hydroxychloroquine on vascular events in patients with systemic lupus erythematosus: a database prospective cohort study</atitle><jtitle>Rheumatology (Oxford, England)</jtitle><addtitle>Rheumatology (Oxford)</addtitle><date>2017-12-01</date><risdate>2017</risdate><volume>56</volume><issue>12</issue><spage>2212</spage><epage>2221</epage><pages>2212-2221</pages><issn>1462-0324</issn><eissn>1462-0332</eissn><abstract>The incidence of thromboembolism in patients with SLE is higher than that in the general population. HCQ, widely used to treat lupus, may have vascular protective effects. The aim of this study was to determine whether long-term HCQ exposure is associated with decreased thromboembolism risk in SLE.
We designed a prospective cohort study within an SLE population based on the National Health Insurance Research Database in Taiwan. We divided participants into HCQ and control groups according to HCQ prescription during the first year. These groups were defined by medication possession ratio (MPR) ⩾80% and MPR = 0%, respectively. Patients with an MPR between 0 and 80% were excluded. The primary outcome was a composite vascular event, including acute coronary syndrome, ischaemic stroke, pulmonary embolism, deep vein thrombosis and peripheral arterial disease 1 year after inclusion. We excluded patients from the cohort if they had outcomes within the first year.
A total of 8397 patients were eligible for analysis. After propensity-score matching, we included 1946 patients in each group. During a mean follow-up of 7.4 years, the number of events was 139 in the HCQ group (7.1%) and 149 in the control group (7.7%). The risk of vascular events in the HCQ group was similar to that in the control group (hazard ratio = 0.91; 95% CI: 0.72, 1.15). Further subgroup analyses confirmed no statistically significant differences between the groups.
Long-term HCQ appears to have no vascular protective effect in patients with SLE.</abstract><cop>England</cop><pmid>29029334</pmid><doi>10.1093/rheumatology/kex357</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Antirheumatic Agents - administration & dosage Antirheumatic Agents - adverse effects Databases, Factual Female Follow-Up Studies Humans Hydroxychloroquine - administration & dosage Hydroxychloroquine - adverse effects Incidence Lupus Erythematosus, Systemic - drug therapy Male Middle Aged Propensity Score Prospective Studies Taiwan Time Vascular Diseases - chemically induced Vascular Diseases - epidemiology Young Adult |
title | Effect of long-term hydroxychloroquine on vascular events in patients with systemic lupus erythematosus: a database prospective cohort study |
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