Hydroxychloroquine treatment in a community-based cohort of patients with systemic lupus erythematosus.
OBJECTIVE
In recent years hydroxychloroquine (HCQ) has emerged as a key therapy in systemic lupus erythematosus (SLE). We determined the rates of HCQ use in a diverse, community-based cohort of patients with SLE and identified predictors of current HCQ use.


METHODS
Patients were participants in the University of California San Francisco Lupus Outcomes Study, an ongoing longitudinal study of patients with confirmed SLE. We examined the prevalence of HCQ use per person-year and compared baseline characteristics of users and nonusers, including demographic, socioeconomic, clinical, and health system use variables. Multiple logistic regression with generalized estimating equations was used to evaluate predictors of HCQ use.


RESULTS
A total of 881 patients contributed 3,095 person-years of data over 4 interview cycles. The prevalence of HCQ use was 55 per 100 person-years and was constant throughout the observation period. In multivariate models, the odds of HCQ use were nearly doubled among patients receiving their SLE care from a rheumatologist compared with those identifying generalists or nephrologists as their primary sources of SLE care. In addition, patients with shorter disease duration were more likely to use HCQ, even after adjusting for age and other covariates.


CONCLUSIONS
In this community-based cohort of patients, HCQ use was suboptimal. Physician specialty and disease duration were the strongest predictors of HCQ use. Patients who are not using HCQ, those with longer disease duration, and those who see nonrheumatologists for their SLE care should be targeted for quality improvement.
Schmajuk
Gabriela
G
Stanford University, Department of Medicine, Division of Rheumatology, Stanford, CA 94304, USA. schmajuk@stanford.edu
Yazdany
Jinoos
J
Trupin
Laura
L
Yelin
Edward
E
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D002140:California; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'
D018501:Antirheumatic Agents; D006886:Hydroxychloroquine
Arthritis Rheum. 2008 Jan 15;59(1):136-43
18163398
Lupus. 2001;10(6):401-4
11434574
Lupus. 2001;10(6):385-7
11434570
Medicine (Baltimore). 2003 Sep;82(5):299-308
14530779
Lupus. 2002;11(6):356-61
12139373
Lupus. 2006;15(6):366-70
16830883
Ethn Dis. 2008 Spring;18(2 Suppl 2):S2-205-10
18646350
Ann Rheum Dis. 1992 Dec;51(12):1318-21
1485814
Inquiry. 1996-1997 Winter;33(4):373-89
9031653
Lupus. 1998;7(2):80-5
9541091
Am J Med Qual. 2009 Nov-Dec;24(6):505-11
19762553
Ann Rheum Dis. 2010 Jan;69(1):20-8
19103632
Circulation. 2003 Jun 10;107(22):2799-804
12756157
Lupus. 2006;15(9):577-83
17080912
Med Care. 2004 Jul;42(7):649-52
15213489
Med Care. 2006 Feb;44(2):132-40
16434912
JAMA. 2007 Jul 11;298(2):187-93
17622600
Lupus. 2006;15(10):700-4
17120601
Ann Rheum Dis. 2007 Sep;66(9):1168-72
17389655
Arthritis Rheum. 2005 May;52(5):1473-80
15880829
Arthritis Rheum. 2007 Aug 15;57(6):928-34
17665462
Ann Rheum Dis. 2009 Feb;68(2):238-41
18782792
Med Care. 2002 Dec;40(12):1270-82
12458308
Lupus. 2008 Apr;17(4):271-3
18413405
Lupus. 1996 Jun;5 Suppl 1:S16-22
8803905
Lupus. 2003;12(4):280-6
12729051