Document Detail


Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-associated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquine.
MedLine Citation:
PMID:  20447951     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Based on the potential involvement of Toll-like receptor (TLR) signalling in the pathogenesis of neonatal lupus (NL), it was hypothesised that fetal exposure to hydroxychloroquine (HCQ), a TLR inhibitor, might reduce the risk of anti-SSA/Ro/SSB/La antibody-associated cardiac manifestations of NL (cardiac-NL).
METHODS: Cardiac-NL children (N=50) and controls (N=151) were drawn from the following overlapping pregnancy studies: Research Registry for NL; PR Interval and Dexamethasone Evaluation in Cardiac-NL; and Predictors of Pregnancy Outcomes: Biomarkers in Antiphospholipid Syndrome and Systemic Lupus Erythematosus (SLE). Pregnancies met the following inclusion criteria: documentation of maternal anti-SSA/Ro/SSB/La antibodies at pregnancy, confirmation of medication use and child's outcome, a diagnosis of SLE before pregnancy and birth by 31 December 2007.
RESULTS: Seven (14%) of the cardiac-NL children were exposed to HCQ compared with 56 (37%) of the controls (p=0.002; OR 0.28; 95% CI 0.12 to 0.63). Cases and controls were similar with respect to demographic and antibody status. Multivariable analysis adjusting for birth year, maternal race/ethnicity, antibody status, non-fluorinated steroid use and prior cardiac-NL risk yielded an OR associated with HCQ use of 0.46 (95% CI 0.18 to 1.18; p=0.10).
CONCLUSION: This case-control study suggests that, in mothers with SLE with anti-SSA/Ro/SSB/La antibodies, exposure to HCQ during pregnancy may decrease the risk of fetal development of cardiac-NL. Prospective studies are needed for confirmation.
Authors:
Peter M Izmirly; Mimi Y Kim; Carolina Llanos; Phuong U Le; Marta M Guerra; Anca D Askanase; Jane E Salmon; Jill P Buyon
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-05-06
Journal Detail:
Title:  Annals of the rheumatic diseases     Volume:  69     ISSN:  1468-2060     ISO Abbreviation:  Ann. Rheum. Dis.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-22     Completed Date:  2010-10-15     Revised Date:  2014-09-22    
Medline Journal Info:
Nlm Unique ID:  0372355     Medline TA:  Ann Rheum Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  1827-30     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Antirheumatic Agents / therapeutic use*
Autoantibodies / blood
Autoantigens / immunology
Case-Control Studies
Female
Heart Diseases / etiology,  immunology,  prevention & control*
Humans
Hydroxychloroquine / therapeutic use*
Infant, Newborn
Lupus Erythematosus, Systemic / complications,  drug therapy*,  immunology
Male
Maternal-Fetal Exchange
Pregnancy
Pregnancy Complications / drug therapy*,  immunology
Prenatal Exposure Delayed Effects
Ribonucleoproteins / immunology
Grant Support
ID/Acronym/Agency:
AR-046265/AR/NIAMS NIH HHS; AR-4-2271/AR/NIAMS NIH HHS; AR-42455/AR/NIAMS NIH HHS; N01 AR042220/AR/NIAMS NIH HHS; R01 AR049772/AR/NIAMS NIH HHS; R01 AR49772/AR/NIAMS NIH HHS; R37 AR042455/AR/NIAMS NIH HHS
Chemical
Reg. No./Substance:
0/Antirheumatic Agents; 0/Autoantibodies; 0/Autoantigens; 0/Ribonucleoproteins; 0/SS-A antigen; 0/SS-B antigen; 4QWG6N8QKH/Hydroxychloroquine
Comments/Corrections

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