Association of Hydroxychloroquine Use with a Dose-Dependent Decrease in Mortality Risk in Patients with Elderly-Onset Rheumatoid Arthritis
Abstract Introduction Elderly-onset rheumatoid arthritis (EORA) is associated with an increased mortality risk; however, the effect of conventional synthetic, biologics or targeted synthetic disease-modifying anti-rheumatic drugs (csDMARDs, bDMARDs or tsDMARDs) on the EORA-specific mortality risk is...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Adis, Springer Healthcare
2023-05-01
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| Series: | Rheumatology and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s40744-023-00561-1 |
| _version_ | 1797784437355708416 |
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| author | Ching-Tsai Lin Wen-Nan Huang Jun-Peng Chen Wei-Ting Hung Tsu-Yi Hsieh Hsin-Hua Chen Kuo-Tung Tang Der-Yuan Chen Yi-Hsing Chen Yi-Ming Chen |
| author_facet | Ching-Tsai Lin Wen-Nan Huang Jun-Peng Chen Wei-Ting Hung Tsu-Yi Hsieh Hsin-Hua Chen Kuo-Tung Tang Der-Yuan Chen Yi-Hsing Chen Yi-Ming Chen |
| author_sort | Ching-Tsai Lin |
| collection | DOAJ |
| description | Abstract Introduction Elderly-onset rheumatoid arthritis (EORA) is associated with an increased mortality risk; however, the effect of conventional synthetic, biologics or targeted synthetic disease-modifying anti-rheumatic drugs (csDMARDs, bDMARDs or tsDMARDs) on the EORA-specific mortality risk is unknown. In this study, we investigated the risk factors for all-cause mortality of patients with EORA. Methods Data of EORA patients diagnosed with RA at age > 60 years between January 2007 and June 2021 were extracted from the electronic health record of Taichung Veterans General Hospital, Taiwan. Multivariable Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). The survival of patients with EORA was analyzed by Kaplan-Meier method. Results Among the 980 EORA patients who were enrolled (survivors 852 and non-survivor 128), the significant mortality-associated risk factors [HR (95% CI)] included higher age (1.10 [1.07–1.12], p < 0.001), male sex (1.92 [1.22–3.00], p = 0.004), current smoker (2.31 [1.10–4.87], p = 0.027) and underlying malignancy (1.89 [1.20–2.97], p = 0.006). Hydroxychloroquine treatment conferred protection against mortality in patients with EORA (HR 0.30, 95% CI 0.14–0.64, p = 0.002). Patients with malignancy who did not receive hydroxychloroquine treatment had the highest mortality risk compared with their counterparts. Patients with a monthly cumulative dose of hydroxychloroquine dose < 1374.5 mg had the lowest survival rate compared to patients who received hydroxychloroquine 1374.5–5778.5 and ≥ 5778.5 mg. Conclusion Hydroxychloroquine treatment is associated with survival benefits in patients with EORA, and prospective studies are needed to validate the abovementioned findings. |
| first_indexed | 2024-03-13T00:39:52Z |
| format | Article |
| id | doaj.art-9cda4de07e3848779ffeb2e74e49bcf3 |
| institution | Directory Open Access Journal |
| issn | 2198-6576 2198-6584 |
| language | English |
| last_indexed | 2024-03-13T00:39:52Z |
| publishDate | 2023-05-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Rheumatology and Therapy |
| spelling | doaj.art-9cda4de07e3848779ffeb2e74e49bcf32023-07-09T11:24:26ZengAdis, Springer HealthcareRheumatology and Therapy2198-65762198-65842023-05-0110486187410.1007/s40744-023-00561-1Association of Hydroxychloroquine Use with a Dose-Dependent Decrease in Mortality Risk in Patients with Elderly-Onset Rheumatoid ArthritisChing-Tsai Lin0Wen-Nan Huang1Jun-Peng Chen2Wei-Ting Hung3Tsu-Yi Hsieh4Hsin-Hua Chen5Kuo-Tung Tang6Der-Yuan Chen7Yi-Hsing Chen8Yi-Ming Chen9Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General HospitalDivision of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General HospitalDepartment of Medical Research, Taichung Veterans General HospitalDivision of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General HospitalDivision of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General HospitalDivision of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General HospitalDivision of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General HospitalRheumatology and Immunology Center, China Medical University HospitalDivision of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General HospitalDivision of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General HospitalAbstract Introduction Elderly-onset rheumatoid arthritis (EORA) is associated with an increased mortality risk; however, the effect of conventional synthetic, biologics or targeted synthetic disease-modifying anti-rheumatic drugs (csDMARDs, bDMARDs or tsDMARDs) on the EORA-specific mortality risk is unknown. In this study, we investigated the risk factors for all-cause mortality of patients with EORA. Methods Data of EORA patients diagnosed with RA at age > 60 years between January 2007 and June 2021 were extracted from the electronic health record of Taichung Veterans General Hospital, Taiwan. Multivariable Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). The survival of patients with EORA was analyzed by Kaplan-Meier method. Results Among the 980 EORA patients who were enrolled (survivors 852 and non-survivor 128), the significant mortality-associated risk factors [HR (95% CI)] included higher age (1.10 [1.07–1.12], p < 0.001), male sex (1.92 [1.22–3.00], p = 0.004), current smoker (2.31 [1.10–4.87], p = 0.027) and underlying malignancy (1.89 [1.20–2.97], p = 0.006). Hydroxychloroquine treatment conferred protection against mortality in patients with EORA (HR 0.30, 95% CI 0.14–0.64, p = 0.002). Patients with malignancy who did not receive hydroxychloroquine treatment had the highest mortality risk compared with their counterparts. Patients with a monthly cumulative dose of hydroxychloroquine dose < 1374.5 mg had the lowest survival rate compared to patients who received hydroxychloroquine 1374.5–5778.5 and ≥ 5778.5 mg. Conclusion Hydroxychloroquine treatment is associated with survival benefits in patients with EORA, and prospective studies are needed to validate the abovementioned findings.https://doi.org/10.1007/s40744-023-00561-1Elderly-onset rheumatoid arthritisMortality riskHydroxychloroquineGeriatricMalignancy |
| spellingShingle | Ching-Tsai Lin Wen-Nan Huang Jun-Peng Chen Wei-Ting Hung Tsu-Yi Hsieh Hsin-Hua Chen Kuo-Tung Tang Der-Yuan Chen Yi-Hsing Chen Yi-Ming Chen Association of Hydroxychloroquine Use with a Dose-Dependent Decrease in Mortality Risk in Patients with Elderly-Onset Rheumatoid Arthritis Rheumatology and Therapy Elderly-onset rheumatoid arthritis Mortality risk Hydroxychloroquine Geriatric Malignancy |
| title | Association of Hydroxychloroquine Use with a Dose-Dependent Decrease in Mortality Risk in Patients with Elderly-Onset Rheumatoid Arthritis |
| title_full | Association of Hydroxychloroquine Use with a Dose-Dependent Decrease in Mortality Risk in Patients with Elderly-Onset Rheumatoid Arthritis |
| title_fullStr | Association of Hydroxychloroquine Use with a Dose-Dependent Decrease in Mortality Risk in Patients with Elderly-Onset Rheumatoid Arthritis |
| title_full_unstemmed | Association of Hydroxychloroquine Use with a Dose-Dependent Decrease in Mortality Risk in Patients with Elderly-Onset Rheumatoid Arthritis |
| title_short | Association of Hydroxychloroquine Use with a Dose-Dependent Decrease in Mortality Risk in Patients with Elderly-Onset Rheumatoid Arthritis |
| title_sort | association of hydroxychloroquine use with a dose dependent decrease in mortality risk in patients with elderly onset rheumatoid arthritis |
| topic | Elderly-onset rheumatoid arthritis Mortality risk Hydroxychloroquine Geriatric Malignancy |
| url | https://doi.org/10.1007/s40744-023-00561-1 |
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