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Systemic Lupus Erythematosus
Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis: LXV, data from a multiethnic US cohort
Article first published online: 28 MAY 2009
DOI: 10.1002/art.24538
Copyright © 2009 by the American College of Rheumatology
1529-0131a/asset/cover.gif?v=1&s=4b71f39689e424fbb0e6725b1c033cc646a4272b "Arthritis Care & Research")
Additional Information
How to Cite
Pons-Estel, G. J., Alarcón, G. S., McGwin, G., Danila, M. I., Zhang, J., Bastian, H. M., Reveille, J. D. and Vilá, L. M. (2009), Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis: LXV, data from a multiethnic US cohort. Arthritis Care & Research, 61: 830–839. doi: 10.1002/art.24538
Publication History
- Issue published online: 28 MAY 2009
- Article first published online: 28 MAY 2009
- Manuscript Accepted: 27 FEB 2009
- Manuscript Received: 6 NOV 2008
Funded by
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Number: P01-AR49084
- General Clinical Research Centers grant to the University of Texas Health Science Center at Houston. Grant Number: M01-RR02558
- University of Alabama at Birmingham. Grant Number: M01-RR00032
- Award from the National Center for Research Resources (NCRR/NIH) RCMI Clinical Research Infrastructure Initiative to the University of Puerto Rico Medical Sciences Campus. Grant Number: 1P20RR11126
- Supporting Training Efforts in Lupus for Latin American Rheumatologists program
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Abstract
Objective
To assess whether hydroxychloroquine can delay renal damage development in lupus nephritis patients.
Methods
Lupus nephritis patients (n = 256) from the LUpus in MInorities, NAture versus nurture study (n = 635), a multiethnic cohort of African Americans, Hispanics, and Caucasians, age ≥16 years with disease duration ≤5 years at baseline (T0) were studied. Renal damage was defined using the Systemic Lupus International Collaborating Clinics Damage Index (≥1 of the following lasting at least 6 months: estimated/measured glomerular filtration rate <50%, 24-hour proteinuria ≥3.5 gm and/or end-stage renal disease, regardless of dialysis or transplantation). Patients with renal damage before T0 were excluded (n = 53). The association between hydroxychloroquine use and renal damage (as defined, or omitting proteinuria) was estimated using Cox proportional regression analyses adjusting for potential confounders. Kaplan-Meier survival curves based on hydroxychloroquine intake or the World Health Organization (WHO) class glomerulonephritis were also derived.
Results
Sixty-three (31.0%) of the 203 patients included developed renal damage over a mean ± SD disease duration of 5.2 ± 3.5 years. The most frequent renal damage domain item was proteinuria. Patients who received hydroxychloroquine (79.3%) exhibited a lower frequency of WHO class IV glomerulonephritis, had lower disease activity, and received lower glucocorticoid doses than those who did not take hydroxychloroquine. After adjusting for confounders, hydroxychloroquine was protective of renal damage occurrence in full (hazard ratio [HR] 0.12, 95% confidence interval [95% CI] 0.02–0.97, P = 0.0464) and reduced (HR 0.29, 95% CI 0.13–0.68, P = 0.0043) models. Omitting proteinuria provided comparable results. The cumulative probability of renal damage occurrence was higher in those who did not take hydroxychloroquine and those classified as WHO class IV glomerulonephritis (P < 0.0001).
Conclusion
After adjusting for possible confounding factors, the protective effect of hydroxychloroquine in retarding renal damage occurrence in systemic lupus erythematosus is still evident.