| Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. | |
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MedLine Citation:
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PMID: 22626746 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2012-05-24 |
Journal Detail:
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Title: Circulation Volume: 126 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2012 Jul |
Date Detail:
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Created Date: 2012-07-03 Completed Date: 2012-09-17 Revised Date: 2013-04-16 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 76-82 Citation Subset: AIM; IM |
Affiliation:
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Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA. Peter.Izmirly@nyumc.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Antibodies, Antinuclear / blood* Cohort Studies Databases, Factual Female France / epidemiology Great Britain / epidemiology Humans Hydroxychloroquine / therapeutic use* Lupus Erythematosus, Systemic / blood, congenital*, epidemiology, prevention & control Male Pregnancy Pregnancy Complications, Cardiovascular / blood*, epidemiology, prevention & control* Recurrence / prevention & control Risk Factors United States / epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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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 |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Antinuclear; 0/SS-A antibodies; 118-42-3/Hydroxychloroquine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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