title: Hydroxychloroquine treatment in a community-based cohort of patients with systemic lupus erythematosus.
abstract: 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.
authors.affiliation: Stanford University, Department of Medicine, Division of Rheumatology, Stanford, CA 94304, USA. schmajuk@stanford.edu
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Edward
authors.initials: E
authors.lastname: Yelin
mesh_terms: 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'
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine
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