Effect of long-term hydroxychloroquine on vascular events in patients with systemic lupus erythematosus: a database prospective cohort study
Abstract
Objectives: The incidence of thromboembolism in patients with SLE is higher than that in the general population. HCQ, widely used to treat lupus, may have vascular protective effects. The aim of this study was to determine whether long-term HCQ exposure is associated with decreased thromboembolism risk in SLE. Methods: We designed a prospective cohort study within an SLE population based on the National Health Insurance Research Database in Taiwan. We divided participants into HCQ and control groups according to HCQ prescription during the first year. These groups were defined by medication possession ratio (MPR) ⩾80% and MPR = 0%, respectively. Patients with an MPR between 0 and 80% were excluded. The primary outcome was a composite vascular event, including acute coronary syndrome, ischaemic stroke, pulmonary embolism, deep vein thrombosis and peripheral arterial disease 1 year after inclusion. We excluded patients from the cohort if they had outcomes within the first year. Results: A total of 8397 patients were eligible for analysis. After propensity-score matching, we included 1946 patients in each group. During a mean follow-up of 7.4 years, the number of events was 139 in the HCQ group (7.1%) and 149 in the control group (7.7%). The risk of vascular events in the HCQ group was similar to that in the control group (hazard ratio = 0.91; 95% CI: 0.72, 1.15). Further subgroup analyses confirmed no statistically significant differences between the groups. Conclusion: Long-term HCQ appears to have no vascular protective effect in patients with SLE.
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Prior retrospective and prospective studies have shown that hydroxychloroquine lowers the risk of arterial and venous thrombosis in systemic lupus erythematosus.
“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 [8]
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Petri, M., Konig, M. F., Li, J., & Goldman, D. W. (2021) · Arthritis & Rheumatology · doi:10.1002/art.41621 · Cited by 65 · see citing works
- Authors
- Hsu, C.-Y., Lin, Y.-S., Su, Y.-J., Lin, H.-F., Lin, M.-S., Syu, Y.-J., Cheng, T.-T., Yu, S.-F., Chen, J.-F., & Chen, T.-H.
- Affiliations
- Chang Gung University (TW)
- Chang Gung Memorial Hospital (TW)
- Corresponding author
- Chen, Tien-Hsing
- ORCID
- Venue
- Rheumatology
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-09-27
- Volume
- 56
- Issue
- 12
- Pages
- 2212-2221
- ISSN
- 1462-0324 (ISSN-L)
- 1462-0332
- OpenAlex
- W2758795254
- Cited by
- 38
- References
- 48
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 3 · 2019: 2 · 2018: 3
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Lara D. Veeken (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Chang Gung Medical Foundation
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Pathology and Forensic Medicine › Systemic Sclerosis and Related Diseases
- Keywords
- hydroxychloroquine, systemic lupus erythematosus, thromboembolism, vascular events, acute coronary syndrome, ischemic stroke, pulmonary embolism, deep vein thrombosis, peripheral arterial disease, vascular protection, long-term drug exposure
- MeSH terms
- Adolescent, Adult, Female, Follow-Up Studies, Humans, Hydroxychloroquine, Lupus Erythematosus, Systemic, Male, Middle Aged, Prospective Studies, Taiwan, Time, Vascular Diseases, Incidence, Databases, Factual, Antirheumatic Agents, Young Adult, Propensity Score
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