title: Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus.
abstract: BACKGROUND
  A recent case-control study suggested a benefit of hydroxychloroquine (HCQ) in lowering the risk of cardiac manifestations of neonatal lupus (cardiac-NL) in pregnancies of anti-SSA/Ro-positive patients with systemic lupus erythematosus. A historical cohort assembled from 3 international databases was used to evaluate whether HCQ reduces the nearly 10-fold increase in risk of recurrence of cardiac-NL independently of maternal health status.
  
  
  RESULTS
  Two hundred fifty-seven pregnancies of anti-SSA/Ro-positive mothers (40 exposed and 217 unexposed to HCQ) subsequent to the birth of a child with cardiac-NL were identified from 3 databases (United States, England, and France). Exposure was defined as the sustained use of HCQ throughout pregnancy with initiation before 10 weeks of gestation. The recurrence rate of cardiac-NL in fetuses exposed to HCQ was 7.5% (3 of 40) compared with 21.2% (46 of 217) in the unexposed group (P=0.050). Although there were no deaths in the exposed group, the overall case fatality rate of the cardiac-NL fetuses in the unexposed group was 21.7%. In a multivariable analysis that adjusted for database source, maternal race/ethnicity, and anti-SSB/La status, HCQ use remained significantly associated with a decreased risk of cardiac-NL (odds ratio, 0.23; 95% confidence interval, 0.06-0.92; P=0.037). Similar results were obtained with propensity score analysis, an alternative approach to adjust for possible confounding by indication.
  
  
  CONCLUSIONS
  Aggregate data from a multinational effort show that in mothers at high risk of having a child with cardiac-NL, the use of HCQ may protect against recurrence of disease in a subsequent pregnancy.
authors.affiliation: Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA. Peter.Izmirly@nyumc.org
authors.forename: Peter M
authors.initials: PM
authors.lastname: Izmirly
authors.forename: Nathalie
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.forename: Cecilia N
authors.initials: CN
authors.lastname: Pisoni
authors.forename: Munther A
authors.initials: MA
authors.lastname: Khamashta
authors.forename: Mimi Y
authors.initials: MY
authors.lastname: Kim
authors.forename: Amit
authors.initials: A
authors.lastname: Saxena
authors.forename: Deborah
authors.initials: D
authors.lastname: Friedman
authors.forename: Carolina
authors.initials: C
authors.lastname: Llanos
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Piette
authors.forename: Jill P
authors.initials: JP
authors.lastname: Buyon
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000151:congenital* / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D055502:Secondary Prevention; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D000974:Antibodies, Antinuclear; C035356:SS-A antibodies; D006886:Hydroxychloroquine