Document Detail

Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus.
MedLine Citation:
PMID:  22626746     Owner:  NLM     Status:  MEDLINE    
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.
METHODS AND 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.
CONCLUSION: 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.
Peter M Izmirly; Nathalie Costedoat-Chalumeau; Cecilia N Pisoni; Munther A Khamashta; Mimi Y Kim; Amit Saxena; Deborah Friedman; Carolina Llanos; Jean-Charles Piette; Jill P Buyon
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-05-24
Journal Detail:
Title:  Circulation     Volume:  126     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-03     Completed Date:  2012-09-17     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  76-82     Citation Subset:  AIM; IM    
Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA.
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MeSH Terms
Antibodies, Antinuclear / blood*
Cohort Studies
Databases, Factual
France / epidemiology
Great Britain / epidemiology
Hydroxychloroquine / therapeutic use*
Lupus Erythematosus, Systemic / blood,  congenital*,  epidemiology,  prevention & control
Pregnancy Complications, Cardiovascular / blood*,  epidemiology,  prevention & control*
Recurrence / prevention & control
Risk Factors
United States / epidemiology
Grant Support
5R37 AR-42455-19/AR/NIAMS NIH HHS; N01 AR042220/AR/NIAMS NIH HHS; N01-AR-4-2220-11-0-1/AR/NIAMS NIH HHS; R37 AR042455/AR/NIAMS NIH HHS
Reg. No./Substance:
0/Antibodies, Antinuclear; 0/SS-A antibodies; 118-42-3/Hydroxychloroquine

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