Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry
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...
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1227403/full |
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| author | Chiharu Hidekawa Ryusuke Yoshimi Ryusuke Yoshimi Yusuke Saigusa Jun Tamura Noriko Kojitani Naoki Suzuki Natsuki Sakurai Yuji Yoshioka Yumiko Sugiyama-Kawahara Yosuke Kunishita Daiga Kishimoto Kana Higashitani Yuichiro Sato Takaaki Komiya Hideto Nagai Naoki Hamada Ayaka Maeda Naomi Tsuchida Lisa Hirahara Yutaro Soejima Kaoru Takase-Minegishi Yohei Kirino Nobuyuki Yajima Ken-ei Sada Yoshia Miyawaki Kunihiro Ichinose Shigeru Ohno Hiroshi Kajiyama Shuzo Sato Yasuhiro Shimojima Michio Fujiwara Hideaki Nakajima |
| author_facet | Chiharu Hidekawa Ryusuke Yoshimi Ryusuke Yoshimi Yusuke Saigusa Jun Tamura Noriko Kojitani Naoki Suzuki Natsuki Sakurai Yuji Yoshioka Yumiko Sugiyama-Kawahara Yosuke Kunishita Daiga Kishimoto Kana Higashitani Yuichiro Sato Takaaki Komiya Hideto Nagai Naoki Hamada Ayaka Maeda Naomi Tsuchida Lisa Hirahara Yutaro Soejima Kaoru Takase-Minegishi Yohei Kirino Nobuyuki Yajima Ken-ei Sada Yoshia Miyawaki Kunihiro Ichinose Shigeru Ohno Hiroshi Kajiyama Shuzo Sato Yasuhiro Shimojima Michio Fujiwara Hideaki Nakajima |
| author_sort | Chiharu Hidekawa |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T11:25:54Z |
| format | Article |
| id | doaj.art-250d87a98654495f8ee627fe93606299 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-12T11:25:54Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-250d87a98654495f8ee627fe936062992023-09-01T07:48:14ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-09-011410.3389/fimmu.2023.12274031227403Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registryChiharu Hidekawa0Ryusuke Yoshimi1Ryusuke Yoshimi2Yusuke Saigusa3Jun Tamura4Noriko Kojitani5Naoki Suzuki6Natsuki Sakurai7Yuji Yoshioka8Yumiko Sugiyama-Kawahara9Yosuke Kunishita10Daiga Kishimoto11Kana Higashitani12Yuichiro Sato13Takaaki Komiya14Hideto Nagai15Naoki Hamada16Ayaka Maeda17Naomi Tsuchida18Lisa Hirahara19Yutaro Soejima20Kaoru Takase-Minegishi21Yohei Kirino22Nobuyuki Yajima23Ken-ei Sada24Yoshia Miyawaki25Kunihiro Ichinose26Shigeru Ohno27Hiroshi Kajiyama28Shuzo Sato29Yasuhiro Shimojima30Michio Fujiwara31Hideaki Nakajima32Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanClinical Laboratory Department, Yokohama City University Hospital, Yokohama, JapanDepartment of Biostatistics, Yokohama City University School of Medicine, Yokohama, JapanDepartment of Biostatistics, Yokohama City University School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanCenter for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanDivision of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, JapanDepartment of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku, JapanDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanCenter for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, JapanDepartment of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Morohongo, Japan0Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan1Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan2Department of Rheumatology, Yokohama Rosai Hospital, Yokohama, JapanDepartment of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, JapanObjectivesInfection 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.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1227403/fullsystemic lupus erythematosus (SLE)hydroxychloroquineinfectionAsianmulticenter registry |
| spellingShingle | Chiharu Hidekawa Ryusuke Yoshimi Ryusuke Yoshimi Yusuke Saigusa Jun Tamura Noriko Kojitani Naoki Suzuki Natsuki Sakurai Yuji Yoshioka Yumiko Sugiyama-Kawahara Yosuke Kunishita Daiga Kishimoto Kana Higashitani Yuichiro Sato Takaaki Komiya Hideto Nagai Naoki Hamada Ayaka Maeda Naomi Tsuchida Lisa Hirahara Yutaro Soejima Kaoru Takase-Minegishi Yohei Kirino Nobuyuki Yajima Ken-ei Sada Yoshia Miyawaki Kunihiro Ichinose Shigeru Ohno Hiroshi Kajiyama Shuzo Sato Yasuhiro Shimojima Michio Fujiwara Hideaki Nakajima Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry Frontiers in Immunology systemic lupus erythematosus (SLE) hydroxychloroquine infection Asian multicenter registry |
| title | Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry |
| title_full | Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry |
| title_fullStr | Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry |
| title_full_unstemmed | Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry |
| title_short | Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry |
| title_sort | protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus an observational study using the luna registry |
| topic | systemic lupus erythematosus (SLE) hydroxychloroquine infection Asian multicenter registry |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1227403/full |
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