| Автор | Tsakonas, E |
| Автор | Joseph, L |
| Автор | Esdaile, J, M |
| Автор | Choquette, D |
| Автор | Senécal, J-L |
| Автор | Cividino, A |
| Автор | Danoff, D |
| Автор | Osterland, C, K |
| Автор | Yeadon, C |
| Автор | Smith, C, D |
| Дата выпуска | 1998 |
| dc.description | The ability of antimalarials to moderate severe disease activity in systemic lupus erythematosus (SLE) is plausible but undemonstrated. We evaluated the long-term effectiveness of maintaining treatment with hydroxychloroquine sulphate (HCQ) to prevent major flares in quiescent SLE. Forty-seven patients with quiescent SLE who had been randomized to take HCQ (n = 25) or placebo (n = 22) as part of a 24-week withdrawal trial were evaluated for an additional 3 years. The primary outcome was time to a major flare of SLE which resulted in either the institution of or an increase in the current dosage of prednisone of 10 mg/day or more, or institution of therapy with immunosuppressive agents. Secondary outcomes included the specific subtype of these major flares (glomerulonephritis, vasculitis or other) and hospitalization for an exacerbation of SLE. An intent-to-treat analysis was conducted.Over the 42 months of study, 11 of 22 (50%) patients randomized initially to placebo, and seven of 25 (28%) patients randomized to continue treatment experienced a major flare. The relative risk of major flare for those randomized to continue HCQ compared with controls was 0.43 (95% CI: 0.17, 1.12). The relative risks for subtypes of flares were 0.26 (95% CI: 0.03, 2.54) for nephritis, 0.51 (95% CI: 0.09, 3.08) for vasculitis and 0.65 (95% CI: 0.17, 2.41) for flares characterized by other symptoms. The relative risk of hospitalization for major flare for patients randomized to continue hydroxychloroquine was 0.58 (95% CI: 0.13, 2.60). While the results are not statistically significant, they are compatible with the clinical belief that HCQ has a long-term protective effect against major disease flares in SLE and suggest that on average, HCQ use reduces major flares by 57% (95% CI: 83% reduction to 12% increase). |
| Издатель | Sage Publications |
| Тема | systemic lupus erythematosus |
| Тема | hydroxychloroquine |
| Тема | nephritis |
| Тема | vasculitis |
| Тема | major flare |
| Название | A Long-Term Study of Hydroxychloroquine Withdrawal on Exacerbations in Systemic Lupus Erythematosus |
| Тип | Journal Article |
| DOI | 10.1191/096120398678919778 |
| Print ISSN | 0961-2033 |
| Журнал | Lupus |
| Том | 7 |
| Первая страница | 80 |
| Последняя страница | 85 |
| Аффилиация | Joseph, L, Division of Clinical Epidemiology, Montreal General Hospital, McGill University |
| Аффилиация | Esdaile, J, M, Mary Pack Arthritis Centre and Vancouver General Hospital, University of British Colombia |
| Аффилиация | Senécal, J-L, Notre-Dame Hospital, University of Montreal |
| Аффилиация | Cividino, A, Hamilton Civic Hospital, McMaster University |
| Аффилиация | Danoff, D, Montreal General Hospital, McGill University |
| Аффилиация | Yeadon, C, Royal Victoria Hospital, McGill University |
| Аффилиация | Smith, C, D, Ottawa General Hospital, University of Ottawa |
| Выпуск | 2 |
| Библиографическая ссылка | The Canadian Hydroxychloroquine Study Group. A randomized trial of the effect of withdrawing hydroxychloroquine sulphate in systemic lupus erythematosus. N Engl J Med1991; 324: 150–154. |
| Библиографическая ссылка | Rudnicki RD, Gresham GE, Rothfield NF. The efficacy of antimalarials in systemic lupus erythematosus. J Rheumatol1975; 2: 323–330. |
| Библиографическая ссылка | Dubois EL. Antimalarials in the management of discoid and systemic lupus erythematosus. Semin Arthritis Rheum1978; 8: 33–51. |
| Библиографическая ссылка | Ziff M, Esserman P, McEwan C. Observations on the course and treatment of systemic lupus erythematosus. Arthritis Rheum1958; 1: 332–350. |
| Библиографическая ссылка | Fox RI, Kang H-I. Mechanism of action of antimalarial drugs: inhibition of antigen processing and presentation. Lupus1993; 2(Suppl 1): S9–S12. |
| Библиографическая ссылка | Sperber K et al. Selective regulation of cytokine secretion by hydroxychloroquine: Inhibition of IL-1 and IL-6 by monocytes and T-cells. J Rheumatol 1993; 20: 803–808. |
| Библиографическая ссылка | Wallace DJ et al. The effect of hydroxychloroquine therapy on soluble accessory factors and cytokines in systemic lupus erythematosus. J Rheumatol 1994; 21: 375–376. |
| Библиографическая ссылка | Wallace DJ: Antimalarial drugs. In: Wallace DJ, Hahn BH (eds). Duboisʼ Lupus Erythematosus (4th edn). Philadelphia, Lea 573-573. |
| Библиографическая ссылка | Wallace DJ. Antimalarials agents and lupus. Rheum Dis Clin North Am1994; 20: 243–263. |
| Библиографическая ссылка | Tan EM et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271–1277. |
| Библиографическая ссылка | Borenstein M. The case for confidence intervals in controlled trials. Controlled Clin Trials1994; 15: 411–428. |
| Библиографическая ссылка | Kaplan EL, Meier P. Non-parametric estimation from incomplete observations. J Am Stat Assoc1958; 53: 457–481. |
| Библиографическая ссылка | Cox DR. Regression models and life tables. J R Stat Soc (series B)1972; 34: 187–220. |
| Библиографическая ссылка | Meenan RF, Gertman PM, Mason JH. Measuring health status in arthritis: the arthritis impact measurement scales. Arthritis Rheum1989; 23: 146–152. |
| Библиографическая ссылка | Urowitz MB, Gladman DD, Tozman EC, Goldsmith CH. The lupus activity criteria count (LACC). J Rheumatol1984; 11: 783–787. |
| Библиографическая ссылка | Bombardier C et al. and the committee on prognosis studies in SLE. Derivation of the SLEDAI: a disease activity index for lupus patients. Arthritis Rheum 1992; 35: 1630–1640. |
| Библиографическая ссылка | Meinão IM et al. Controlled trial with chloroquine diphosphate in systemic lupus erythematosus. Lupus 1996; 5: 237–241. |
| Библиографическая ссылка | Feinstein AR. Clinical Epidemiology. The Architecture of Clinical Research. WB Saunders Co., Philadelphia, 1985. |
| Библиографическая ссылка | Swaak et al. Systemic lupus erythematosus II. Observations on the occurrence of exacerbations in the disease course: Dutch experience with 110 patients studied prospectively. Ann Rheum Dis 1989; 48: 455–460. |
| Библиографическая ссылка | Petri M, Genovese M. Incidence of 5 risk factors for hospitalizations in systemic lupus erythematosus: a prospective study of the Hopkins lupus cohort. J Rheumatol1992; 19: 1559–1565. |
| Библиографическая ссылка | Clarke AE et al. A Canadian study of the total medical care costs for patients with systemic lupus erythematosus and the predictors of costs. Arthritis Rheum 1993; 36: 1548–1559. |
| Библиографическая ссылка | McInnes PM et al. The economic impact of treatment of severe lupus nephritis with prednisone and intravenous cyclophosphamide. Arthritis Rheum 1994; 37: 1000–1006. |
