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Multicenter Study
. 2009 Jun 15;61(6):830-9.
doi: 10.1002/art.24538.

Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis: LXV, data from a multiethnic US cohort

Guillermo J Pons-Estel  1 , Graciela S Alarcón, Gerald McGwin Jr, Maria I Danila, Jie Zhang, Holly M Bastian, John D Reveille, Luis M Vilá; Lumina Study Group
Affiliations
Multicenter Study

Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis: LXV, data from a multiethnic US cohort

Guillermo J Pons-Estel et al. Arthritis Rheum. .

Abstract

Objective: To assess whether hydroxychloroquine can delay renal damage development in lupus nephritis patients.

Methods: Lupus nephritis patients (n = 256) from the LUpus in MInorities, NAture versus nurture study (n = 635), a multiethnic cohort of African Americans, Hispanics, and Caucasians, age > or =16 years with disease duration < or =5 years at baseline (T0) were studied. Renal damage was defined using the Systemic Lupus International Collaborating Clinics Damage Index (> or =1 of the following lasting at least 6 months: estimated/measured glomerular filtration rate <50%, 24-hour proteinuria > or =3.5 gm and/or end-stage renal disease, regardless of dialysis or transplantation). Patients with renal damage before T0 were excluded (n = 53). The association between hydroxychloroquine use and renal damage (as defined, or omitting proteinuria) was estimated using Cox proportional regression analyses adjusting for potential confounders. Kaplan-Meier survival curves based on hydroxychloroquine intake or the World Health Organization (WHO) class glomerulonephritis were also derived.

Results: Sixty-three (31.0%) of the 203 patients included developed renal damage over a mean +/- SD disease duration of 5.2 +/- 3.5 years. The most frequent renal damage domain item was proteinuria. Patients who received hydroxychloroquine (79.3%) exhibited a lower frequency of WHO class IV glomerulonephritis, had lower disease activity, and received lower glucocorticoid doses than those who did not take hydroxychloroquine. After adjusting for confounders, hydroxychloroquine was protective of renal damage occurrence in full (hazard ratio [HR] 0.12, 95% confidence interval [95% CI] 0.02-0.97, P = 0.0464) and reduced (HR 0.29, 95% CI 0.13-0.68, P = 0.0043) models. Omitting proteinuria provided comparable results. The cumulative probability of renal damage occurrence was higher in those who did not take hydroxychloroquine and those classified as WHO class IV glomerulonephritis (P < 0.0001).

Conclusion: After adjusting for possible confounding factors, the protective effect of hydroxychloroquine in retarding renal damage occurrence in systemic lupus erythematosus is still evident.

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Figures

Figure 1
Figure 1
Graphic representation of LUMINA patients included in this study and all others. LUMINA-Lupus in Minorities: Nature vs. Nurture; T0:Baseline or recruitment visit; TL: last visit or development of renal damage.
Figure 2
Figure 2
Cumulative probability of developing renal-damage in LUMINA patients with lupus nephritis by Kaplan-Meier survival analyses. Tables below show the number of patients at risk at each time point 2a. As a function of hydroxychloroquine intake 2b. As a function of the presence of WHO Class IV glomerulonephritis
Figure 2
Figure 2
Cumulative probability of developing renal-damage in LUMINA patients with lupus nephritis by Kaplan-Meier survival analyses. Tables below show the number of patients at risk at each time point 2a. As a function of hydroxychloroquine intake 2b. As a function of the presence of WHO Class IV glomerulonephritis
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