This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via ISI Web of Science (1) Google Scholar Articles by Sisó, A Articles by Coca, A PubMed PubMed Citation Articles by Sisó, A Articles by Coca, A Social Bookmarking                   What's this?

Previous antimalarial therapy in patients diagnosed with lupus nephritis: Influence on outcomes and survival

Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases "Josep Font", Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Statistical Unit, Barcelona, Spain; Centre d’Assistència Primària ABS Les Corts, GESCLINIC, Barcelona, Spain

M Ramos-Casals

Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases "Josep Font", Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Statistical Unit, Barcelona, Spain

A Bové

Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases "Josep Font", Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Statistical Unit, Barcelona, Spain

P Brito-Zerón

Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases "Josep Font", Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Statistical Unit, Barcelona, Spain

N Soria

Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases "Josep Font", Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Statistical Unit, Barcelona, Spain

S Muñoz

Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases "Josep Font", Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Statistical Unit, Barcelona, Spain

A Testi

Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases "Josep Font", Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Statistical Unit, Barcelona, Spain

J Plaza

Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases "Josep Font", Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Statistical Unit, Barcelona, Spain

J Sentís

Department of Public Health, School of Medicine, University of Barcelona, Barcelona, Spain

A Coca

Hypertension Unit, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Spain

The aim of this study was to analyze the effect of exposure to antimalarial drugs at diagnosis of lupus nephritis on the outcome of the disease, especially renal failure, comorbid processes, and survival. We analyzed a cohort of 206 consecutive patients with biopsy-proven lupus nephritis. Renal biopsies were categorized according to the classification proposed by the ISN/RPS in 2003. Exposure to antimalarial drugs (chloroquine and hydroxychloroquine) was defined as the use of these drugs before the diagnosis of lupus nephritis independent of dose and duration. Fifty-six (27%) patients had received antimalarials before the diagnosis of lupus nephritis. During the follow-up, these patients had a lower frequency of creatinine values >4 mg/dL (2% vs 11%, P = 0.029) and end-stage renal failure (2% vs 11%, P = 0.044) in comparison with those never treated with antimalarials. Patients exposed to antimalarials also had a lower frequency of hypertension (32% vs 50%, P = 0.027), infections (11% vs 29%, P = 0.006), and thrombotic events (5% vs 17%, P = 0.039). Twenty patients (10%) died during the study period. Patients exposed to antimalarials had a lower mortality rate at the end of the follow-up (2% vs 13% for those not exposed to antimalarials, P = 0.029). Multivariate analysis identified thrombosis and infections as statistically significant independent variables. Kaplan–Meier plots showed a lower rate of end-stage renal failure (log rank = 0.04) in patients exposed to antimalarials. In conclusion, exposure to antimalarials before the diagnosis of lupus nephritis was negatively associated with the development of renal failure, hypertension, thrombosis and infection, and with a better survival rate at the end of the follow-up. This, together with other published data, suggests that antimalarials should be considered a mandatory therapeutic option in all patients diagnosed with systemic lupus erythematosus.

Key Words: antimalarials • cardiovascular disease • hydroxychloroquine • lupus nephropathy • mortality • systemic lupus erythematosus • thrombosis

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?