Antimalarials May Have Survival Benefit in SLE


LONDON — The list of reasons for treating patients who have lupus with antimalarial drugs now includes long-term survival benefits, according to a Spanish cohort study.

Antimalarials have proved beneficial for several aspects of systemic lupus erythematosus (SLE), such as for controlling disease activity, improving lipid profiles, and preventing thrombosis. But an analysis of 15 years' follow-up in a group of 232 patients now has shown significant differences in survival between those treated with antimalarial drugs and those never given the drugs, Guillermo Ruiz-Irastorza, M.D., said at the Sixth European Lupus Meeting.

A total of 147 of the 232 patients (64%) in the cohort received an antimalarial at some time during the course of their disease. Thus far 23 have died. The causes of death were thrombosis (seven patients), neoplasm (six patients), infection (five patients), and other (five patients).

Of the 23, there were 19 (83%) who had never received antimalarials, said Dr. Ruiz-Irastorza of the department of internal medicine at Hospital de Cruces, University of the Basque Country, Barakaldo, Spain.

Of those treated with antimalarials, 97% remain alive, he said.

Cumulative 15-year survival rates were 68% for patients not receiving antimalarials, compared with 95% for those treated with antimalarials, which was a statistically significant difference.

After adjusting for independent covariates, including renal disease, thrombosis, neoplasia, presence of irreversible damage 6 months after diagnosis, and age at diagnosis, the adjusted hazard ratio for death at 15 years for those not receiving antimalarials was found to be 3.8, he said at the meeting, sponsored by the British Society for Rheumatology.

The limitations of the study include its nonrandomized design, and the fact that it is a homogeneous population with easy access to health facilities, Dr. Ruiz-Irastorza said. The cohort consisted of 204 women and 28 men; 99% were white.

“But the protective effect is too big to reject,” he said.

These study findings suggest a beneficial effect of antimalarials on the long-term prognosis of patients with SLE. Although these results should be confirmed by randomized clinical trials, they support the routine use of antimalarials in all patients with SLE, given the drugs' safety profile, he said.

Ocular toxicity is rare at the usual dose of 200 mg/day, he noted.

Recommended Reading

Exercise Boosts Mental Health in Osteoporosis
MDedge Family Medicine
Out of Africa: Retrovirus Linked to Autoimmunity
MDedge Family Medicine
Study Links Lupus to a Range of Pulmonary Complications
MDedge Family Medicine
Maternal Vitamin D Affects Child's Bone Mass
MDedge Family Medicine
Watch for Red Flags in Low Back Pain Patients
MDedge Family Medicine
Early Response Key With Botox Injections for Low Back Pain
MDedge Family Medicine
Local Injections Help Delay Spinal Surgery
MDedge Family Medicine
Joint Hypermobility Syndrome Often Overlooked : Care for these patients should be multidisciplinary, and address physical and psychosocial aspects.
MDedge Family Medicine
Osteogenesis Imperfecta Function Tied to BMD Levels
MDedge Family Medicine
Palpable purpura and a visible sock line
MDedge Family Medicine