Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry

Frontiers in Immunology

Immunology

Daiga Kishimoto¹  Shigeru Ohno¹  Jun Tamura²  Yusuke Saigusa²  Ken-ei Sada³  Kunihiro Ichinose⁴  Yasuhiro Shimojima⁵  Yoshia Miyawaki⁶  Hiroshi Kajiyama⁷  Shuzo Sato⁸  Michio Fujiwara⁹  Noriko Kojitani^1,10  Natsuki Sakurai^1,10  Takaaki Komiya^1,10  Yosuke Kunishita^1,10  Naoki Hamada^1,10  Yuji Yoshioka^1,10  Kaoru Takase-Minegishi^1,10  Yumiko Sugiyama-Kawahara^1,10  Yuichiro Sato^1,10  Ayaka Maeda^1,10  Naomi Tsuchida^1,10  Hideto Nagai^1,10  Naoki Suzuki^1,10  Lisa Hirahara^1,10  Yohei Kirino^1,10  Chiharu Hidekawa^1,10  Yutaro Soejima^1,10  Hideaki Nakajima^1,10  Kana Higashitani^1,10  Ryusuke Yoshimi^1,11  Nobuyuki Yajima^1,12 

[1] Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan;Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan;Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku, Japan;Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan;Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan;Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan;Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Morohongo, Japan;Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan;Department of Rheumatology, Yokohama Rosai Hospital, Yokohama, Japan;Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan;Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan;Clinical Laboratory Department, Yokohama City University Hospital, Yokohama, Japan;Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan;

关键词: systemic lupus erythematosus (SLE);    hydroxychloroquine;    infection;    Asian;    multicenter registry;   

DOI  :  10.3389/fimmu.2023.1227403

 received in 2023-05-23, accepted in 2023-08-14,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectivesInfection is a leading cause of death in patients with systemic lupus erythematosus (SLE). Alt hough hydroxychloroquine (HCQ) has been reported to inhibit infection, evidence from Asian populations remains insufficient. We investigated this effect in Japanese SLE patients.MethodsData from the Lupus Registry of Nationwide Institutions were used in this study. The patients were ≥20 years old and met the American College of Rheumatology (ACR) classification criteria revised in 1997. We defined “severe infections” as those requiring hospitalization. We analyzed the HCQ’s effect on infection suppression using a generalized estimating equation (GEE) logistic regression model as the primary endpoint and performed a survival analysis for the duration until the first severe infection.ResultsData from 925 patients were used (median age, 45 [interquartile range 35–57] years; female, 88.1%). GEE analysis revealed that severe infections were significantly associated with glucocorticoid dose (odds ratio [OR] 1.968 [95% confidence interval, 1.379–2.810], p<0.001), immunosuppressants (OR 1.561 [1.025–2.380], p=0.038), and baseline age (OR 1.043 [1.027–1.060], p<0.001). HCQ tended to suppress severe infections, although not significantly (OR 0.590 [0.329–1.058], p=0.077). Survival time analysis revealed a lower incidence of severe infections in the HCQ group than in the non-HCQ group (p<0.001). In a Cox proportional hazards model, baseline age (hazard ratio [HR] 1.029 [1.009–1.050], p=0.005) and HCQ (HR 0.322 [0.142–0.728], p=0.006) were significantly related to incidence.ConclusionHCQ may help extend the time until the occurrence of infection complications and tends to decrease infection rates.

【 授权许可】

Unknown   
Copyright © 2023 Hidekawa, Yoshimi, Saigusa, Tamura, Kojitani, Suzuki, Sakurai, Yoshioka, Sugiyama-Kawahara, Kunishita, Kishimoto, Higashitani, Sato, Komiya, Nagai, Hamada, Maeda, Tsuchida, Hirahara, Soejima, Takase-Minegishi, Kirino, Yajima, Sada, Miyawaki, Ichinose, Ohno, Kajiyama, Sato, Shimojima, Fujiwara and Nakajima