Newswise — A common, low-risk treatment, may prevent kidney damage in patients with lupus, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.
Systemic lupus erythematosus (also called SLE or lupus) is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system, and other organs of the body. One of the most serious complications of lupus is kidney disease, which can progress to renal failure and require dialysis.
Hydroxychloroquine—a drug originally used to prevent and treat malaria—is often used to treat the skin and joint disease associated with lupus. This drug has previously been associated with decreased flares, reduction of physical damage, and better overall survival rates for people with lupus, which recently led researchers to investigate whether hydroxychloroquine can specifically prevent kidney damage in these patients. Side effects from hydroxychloroquine use are less common, and generally less serious, than those from other drugs used to treat lupus, such as corticosteroids and immunosuppressant drugs.
The researchers followed 582 African American, Caucasian and Latin American patients with lupus who were at least 16 years old and had suffered from lupus for less than five years. Patients were divided into two groups; 506 participants received hydroxychloroquine, while 76 did not.
Kidney damage developed in 73 of the 582 patients. Those patients on hydroxychloroquine were less likely to have kidney disease, had less severe disease, and required lower doses of corticosteroids than their counterparts.
After further adjusting for variables associated with taking hydroxychloroquine, the therapy was still found to be highly protective against the occurrence of kidney damage.
"The data presented, taken in conjunction with those previously reported by others, suggest that if renal damage is to be prevented, hydroxychloroquine should be prescribed to all lupus patients very early in the course of the disease, explains Guillermo J. Pons-Estel, MD, departments of medicine, division of clinical immunology and rheumatology, University of Alabama, Birmingham, Birmingham, Ala, and lead investigator in the study. "This practice will have a direct impact not only on the lives of patients with SLE but also on society ¬" given the costs associated with the occurrence of renal damage in these patients."
Patients should talk to their rheumatologists to determine their best course of treatment.
The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see www.rheumatology.org/annual.
Editor's Notes: Dr. Pons-Estel will present this research during the ACR Annual Scientific Meeting at the Moscone Center from 9:45 " 10:00 AM on Wednesday, October 29, in Room 303. Graciela S. Alarcón, MD, MPH, will be available for media questions and briefing at 1:30 PM on Monday, October 27 in the on-site press conference room, 114.
Presentation Number: 2061
Protective Effect of Hydroxychloroquine (HCQ) on Renal Damage in Patients with Systemic Lupus Erythematosus (SLE): Data from a Multiethnic Cohort
Guillermo J. Pons-Estel1, Maria I. Danila1, Gerald McGwin, Jr1, Jie Zhang1, Luis M. Vilá2, John D. Reveille3, Graciela S. Alarcón1, Holly M. Bastian1. 1University of Alabama at Birmingham, Birmingham, AL; 2University of Puerto Rico, San Juan, Puerto Rico; 3University of Texas, Houston, TX
Background and Purpose: HCQ has been shown to be associated with a decreased frequency of flares, reduction on damage accrual and better overall survival rates in lupus. The aim of the present study was to investigate whether HCQ use may specifically prevent the development of renal damage, one of the most serious complications observed in SLE.
Methods: SLE patients (≥4 ACR criteria) from a U.S. multiethnic cohort of African Americans, Hispanics or Caucasians, age ≥16 years, disease duration ≤5 years at baseline (T0) were studied. Renal damage was defined per the SLICC damage index (SDI): glomerular filtration rate <50%, 24 hours protein ≥3.5 g and ESRD; only patients in whom renal damage occurred after T0 were included. Given that HCQ takers usually have milder disease manifestations, variables from the different domains (socioeconomic-demographic, clinical, immunological and genetic) were compared between hydroxychloroquine-takers and non-takers to adjust for confounding; variables with a p ≤0.10 were then included into a multivariable (MV) Cox proportional hazards regression model.
Results: There were 506 HCQ-takers and 76 non-takers. HCQ-takers had, overall, less severe disease manifestations and were treated with lower doses of glucocorticoids (data not shown). Seventy-three (12.5%) of 582 patients developed renal damage over a mean (standard deviation) total disease duration of 5.5 (3.6) years. Table 1 shows the results of the MV Cox regressions analysis.
Conclusions and Implications: After adjusting for variables associated with HCQ intake, HCQ remained highly protective of the occurrence of renal damage. Our data strongly suggest that if renal damage is to be prevented, HCQ should be prescribed to all lupus patients early in the course of the disease. [Table included with press release and full abstract at www.rheumatology.org.]
Disclosure Block: G.J. Pons-Estel, None; M.I. Danila, None; G. McGwin, Jr, None; J. Zhang, None; L.M. Vilá, None; J.D. Reveille, None; G.S. Alarcón, None; H.M. Bastian, None.
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