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The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus
Abstract
Objective: The antimalarial medication hydroxychloroquine has been proposed as a thromboprotective agent in systemic lupus erythematosus (SLE), but studies thus far have been limited by the possibility of confounding by indication. This study was conducted to assess whether exposure to antimalarial drugs is associated with a decrease in thrombovascular events (TEs) in patients with SLE. Methods: The study was designed as a nested case–control study embedded in an inception cohort of patients with SLE, which allowed adjustments for possible confounding by calendar year, duration of disease, duration of observation, and severity of lupus. After controlling for the possible confounding variables in conditional logistic regression models, the use of antimalarial drugs was assessed for its effects on the development of TEs in lupus patients. Results: Fifty‐four cases of TE were identified, and these were matched with 108 control subjects (lupus patients without TEs). Univariate analyses identified older age (odds ratio [OR] 1.04, 95% confidence interval [95%CI] 1.01–1.07) or being older than age 50 years (OR 3.5, 95% CI 1.4–8.6) and ever having hypertension (OR 2.5, 95% CI 1.0–5.8) as being associated with an increased risk of TEs, whereas use of antimalarial drugs (OR 0.31, 95% CI 0.13–0.71) was associated with a decreased risk of TEs. Separate analyses were done for arterial and venous TEs, which yielded similar results. In multivariate analyses, use of antimalarial drugs (OR 0.32, 95% CI 0.14–0.74) and older age (OR 1.04, 95% CI 1.01–1.07) were the only 2 variables that remained significant. Conclusion: The results from this nested case–control study demonstrate that, after accounting for the effects of disease severity, disease duration, and calendar year, antimalarial drugs were found to be thromboprotective, being associated with a 68% reduction in the risk of all TEs, with a range of risk reduction of at least 26% up to as high as 86%.
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“Multiple retrospective and a few prospective studies (3–13) have found that hydroxychloroquine (HCQ) reduces the risk of arterial and venous thrombosis.”
From Association of Higher Hydroxychloroquine Blood Levels With Reduced Thrombosis Risk in Systemic Lupus Erythematosus (2021) · cites this paper as [7]
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Metadata
- Authors
- Jung, H., Bobba, R., Su, J., Shariati‐Sarabi, Z., Gladman, D. D., Urowitz, M., Lou, W., & Fortin, P. R.
- Affiliations
- University of Toronto (CA)
- McMaster University (CA)
- Mashhad University of Medical Sciences (IR)
- ORCID
- Venue
- Arthritis & Rheumatism
- Publisher
- Wiley
- Published
- 2010-02-25
- Volume
- 62
- Issue
- 3
- Pages
- 863-868
- ISSN
- 0004-3591 (ISSN-L)
- 1529-0131
- OpenAlex
- W2024228574
- Cited by
- 291
- References
- 33
- Citations by year
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- FWCI
- 12.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arthritis & Rheumatism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Toronto
- Canadian Institutes of Health Research (49509_1, 64336_1)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- hydroxychloroquine, antimalarial drugs, systemic lupus erythematosus, venous thromboembolism, arterial thromboembolism, hypertension, age as risk factor, confounding by indication
- MeSH terms
- Adult, Antimalarials, Female, Humans, Hydroxychloroquine, Lupus Erythematosus, Systemic, Male, Middle Aged, Thrombosis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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