title: Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus.
abstract: Antimalarials have shown beneficial effects on systemic lupus erythematosus (SLE) activity. Our aim was to investigate whether antimalarials protect against thrombosis and influence survival in SLE patients. A prospective cohort including 232 patients with SLE were included in the study at the time of lupus diagnosis. End points were documented thrombosis and death due to any cause. A Cox regression-multiple-failure time survival analysis model was fitted to establish the effect of antimalarials on the development of thrombosis. Kaplan-Meier survival curves and propensity score adjusted-Cox regression analysis were performed to investigate the effect of antimalarials use on survival. Of our subjects, 204 patients (88%) were women. 230 patients (99%) were white. 150 patients (64%) had ever received antimalarials. Median time on antimalarials was 52 months (range three to 228 months). The Cox multiple-failure time survival analysis showed that taking antimalarials was protective against thrombosis (HR 0.28, 95% CI 0.08-0.90), while aPL-positivity (HR 3.16, 95% CI 1.45-6.88) and previous thrombosis (HR 3.85, 95% CI 1.50-9.91) increased the risk of thrombotic events. Twenty-three patients died, 19 of whom (83%) had never received antimalarials. No patient treated with antimalarials died of cardiovascular complications. Cumulative 15-year survival rates were 0.68 for never versus 0.95 for ever treated patients (P < 0.001). Age at diagnosis and propensity score-adjusted HR for antimalarials ever versus never users was 0.14 (95% CI 0.04-0.48). Our study shows a protective effect of antimalarials against thrombosis and an increased survival of SLE patients taking these drugs. These data support the routine use of antimalarials in all patients with SLE.
authors.affiliation: Department of Internal Medicine, Hospital de Cruces, University of the Basque Country, Bizkaia, Spain. r.irastorza@euskalnet.net
authors.forename: G
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.forename: M V
authors.initials: MV
authors.lastname: Egurbide
authors.forename: J I
authors.initials: JI
authors.lastname: Pijoan
authors.forename: M
authors.initials: M
authors.lastname: Garmendia
authors.forename: I
authors.initials: I
authors.lastname: Villar
authors.forename: A
authors.initials: A
authors.lastname: Martinez-Berriotxoa
authors.forename: J G
authors.initials: JG
authors.lastname: Erdozain
authors.forename: C
authors.initials: C
authors.lastname: Aguirre
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000962:Antimalarials / Q000627:therapeutic use*; D002423:Cause of Death; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors; D013030:Spain; D016019:Survival Analysis; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000962:Antimalarials