Antimalarial Treatment May Have a Time-Dependent Effect on Lupus Survival
Autor(a) principal: | |
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Data de Publicação: | 2010 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/32277 http://dx.doi.org/10.1002/art.27300 |
Resumo: | Objective. To evaluate the beneficial effect of antimalarial treatment on lupus survival in a large, multiethnic, international longitudinal inception cohort.Methods. Socioeconomic and demographic characteristics, clinical manifestations, classification criteria, laboratory findings, and treatment variables were examined in patients with systemic lupus erythematosus (SLE) from the Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohort. the diagnosis of SLE, according to the American College of Rheumatology criteria, was assessed within 2 years of cohort entry. Cause of death was classified as active disease, infection, cardiovascular complications, thrombosis, malignancy, or other cause. Patients were subdivided by antimalarial use, grouped according to those who had received antimalarial drugs for at least 6 consecutive months (user) and those who had received antimalarial drugs for <6 consecutive months or who had never received antimalarial drugs (nonuser).Results. of the 1,480 patients included in the GLADEL cohort, 1,141 (77%) were considered antimalarial users, with a mean duration of drug exposure of 48.5 months (range 6-98 months). Death occurred in 89 patients (6.0%). A lower mortality rate was observed in antimalarial users compared with nonusers (4.4% versus 11.5%; P < 0.001). Seventy patients (6.1%) had received antimalarial drugs for 6-11 months, 146 (12.8%) for 1-2 years, and 925 (81.1%) for >2 years. Mortality rates among users by duration of antimalarial treatment (per 1,000 person-months of followup) were 3.85 (95% confidence interval [95% CI] 1.41-8.37), 2.7 (95% CI 1.41-4.76), and 0.54 (95% CI 0.37-0.77), respectively, while for nonusers, the mortality rate was 3.07 (95% CI 2.18-4.20) (P for trend < 0.001). After adjustment for potential confounders in a Cox regression model, antimalarial use was associated with a 38% reduction in the mortality rate (hazard ratio 0.62, 95% CI 0.39-0.99).Conclusion. Antimalarial drugs were shown to have a protective effect, possibly in a time-dependent manner, on SLE survival. These results suggest that the use of antimalarial treatment should be recommended for patients with lupus. |
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Shinjo, Samuel Katsuyuki [UNIFESP]Bonfa, EloisaWojdyla, DanielBorba, Eduardo F.Ramirez, Luis A.Scherbarth, Hugo R.Tavares Brenol, Joao C.Chacon-Diaz, RosaNeira, Oscar J.Berbotto, Guillermo A.Garcia de La Torre, IgnacioAcevedo-Vazquez, Eduardo M.Massardo, LoretoBarile-Fabris, Leonor A.Caeiro, FranciscoSilveira, Luis H.Sato, Emilia Inoue [UNIFESP]Buliubasich, SandraAlarcon, Graciela S.Pons-Estel, Bernardo A.Grp Latino Amer Estudio Lupus EritHosp Prov RosarioUniversidade de São Paulo (USP)Univ Nacl RosarioUniv AntioquiaHosp Univ San Vicente de PaulHosp Interzonal Gen Agudos Dr Oscar AlendeHosp Clin Porto AlegreUniv Fed Rio Grande do SulHosp Univ CaracasHosp SalvadorUniv ChileHosp Escuela Eva PeronHosp Gen Occidente Secretaria SaludHosp Nacl Guillermo Almenara IrigoyenPontificia Univ Catolica ChileHosp Especialidades Ctr Med Nacl Siglo XXIHosp PrivadoInst Nacl Cardiol Ignacio ChavezUniversidade Federal de São Paulo (UNIFESP)Hosp Nacl ClinUniv Alabama2016-01-24T13:59:20Z2016-01-24T13:59:20Z2010-03-01Arthritis and Rheumatism. Hoboken: Wiley-liss, v. 62, n. 3, p. 855-862, 2010.0004-3591http://repositorio.unifesp.br/handle/11600/32277http://dx.doi.org/10.1002/art.2730010.1002/art.27300WOS:000279432200026Objective. To evaluate the beneficial effect of antimalarial treatment on lupus survival in a large, multiethnic, international longitudinal inception cohort.Methods. Socioeconomic and demographic characteristics, clinical manifestations, classification criteria, laboratory findings, and treatment variables were examined in patients with systemic lupus erythematosus (SLE) from the Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohort. the diagnosis of SLE, according to the American College of Rheumatology criteria, was assessed within 2 years of cohort entry. Cause of death was classified as active disease, infection, cardiovascular complications, thrombosis, malignancy, or other cause. Patients were subdivided by antimalarial use, grouped according to those who had received antimalarial drugs for at least 6 consecutive months (user) and those who had received antimalarial drugs for <6 consecutive months or who had never received antimalarial drugs (nonuser).Results. of the 1,480 patients included in the GLADEL cohort, 1,141 (77%) were considered antimalarial users, with a mean duration of drug exposure of 48.5 months (range 6-98 months). Death occurred in 89 patients (6.0%). A lower mortality rate was observed in antimalarial users compared with nonusers (4.4% versus 11.5%; P < 0.001). Seventy patients (6.1%) had received antimalarial drugs for 6-11 months, 146 (12.8%) for 1-2 years, and 925 (81.1%) for >2 years. Mortality rates among users by duration of antimalarial treatment (per 1,000 person-months of followup) were 3.85 (95% confidence interval [95% CI] 1.41-8.37), 2.7 (95% CI 1.41-4.76), and 0.54 (95% CI 0.37-0.77), respectively, while for nonusers, the mortality rate was 3.07 (95% CI 2.18-4.20) (P for trend < 0.001). After adjustment for potential confounders in a Cox regression model, antimalarial use was associated with a 38% reduction in the mortality rate (hazard ratio 0.62, 95% CI 0.39-0.99).Conclusion. Antimalarial drugs were shown to have a protective effect, possibly in a time-dependent manner, on SLE survival. These results suggest that the use of antimalarial treatment should be recommended for patients with lupus.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Federico Wilhelm Agricola FoundationHosp Prov Rosario, Rheumatol Serv, RA-2000 Rosario, Santa Fe, ArgentinaUniv São Paulo, Fac Med, Hosp Clin, São Paulo, BrazilUniv Nacl Rosario, RA-2000 Rosario, Santa Fe, ArgentinaUniv Antioquia, Medellin, ColombiaHosp Univ San Vicente de Paul, Medellin, ColombiaHosp Interzonal Gen Agudos Dr Oscar Alende, Mar Del Plata, Buenos Aires, ArgentinaHosp Clin Porto Alegre, Porto Alegre, RS, BrazilUniv Fed Rio Grande do Sul, Porto Alegre, RS, BrazilHosp Univ Caracas, Caracas, VenezuelaHosp Salvador, Santiago, ChileUniv Chile, Santiago, ChileHosp Escuela Eva Peron, Rosario, Santa Fe, ArgentinaHosp Gen Occidente Secretaria Salud, Guadalajara, Jalisco, MexicoHosp Nacl Guillermo Almenara Irigoyen, Lima, PeruPontificia Univ Catolica Chile, Santiago, ChileHosp Especialidades Ctr Med Nacl Siglo XXI, Inst Mexicano Seguro Social, Mexico City, DF, MexicoHosp Privado, Ctr Med Cordoba, Cordoba, ArgentinaInst Nacl Cardiol Ignacio Chavez, Mexico City, DF, MexicoUniversidade Federal de São Paulo, São Paulo, BrazilHosp Nacl Clin, Cordoba, ArgentinaUniv Alabama, Birmingham, W Midlands, EnglandUniversidade Federal de São Paulo, EPM, São Paulo, BrazilCNPq: 305468/2006-5CNPq: 3031165/2008-1Web of Science855-862engWiley-BlackwellArthritis and Rheumatismhttp://olabout.wiley.com/WileyCDA/Section/id-406071.htmlinfo:eu-repo/semantics/openAccessAntimalarial Treatment May Have a Time-Dependent Effect on Lupus Survivalinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlereponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP11600/322772022-07-08 10:54:16.303metadata only accessoai:repositorio.unifesp.br:11600/32277Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652022-07-08T13:54:16Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Antimalarial Treatment May Have a Time-Dependent Effect on Lupus Survival |
title |
Antimalarial Treatment May Have a Time-Dependent Effect on Lupus Survival |
spellingShingle |
Antimalarial Treatment May Have a Time-Dependent Effect on Lupus Survival Shinjo, Samuel Katsuyuki [UNIFESP] |
title_short |
Antimalarial Treatment May Have a Time-Dependent Effect on Lupus Survival |
title_full |
Antimalarial Treatment May Have a Time-Dependent Effect on Lupus Survival |
title_fullStr |
Antimalarial Treatment May Have a Time-Dependent Effect on Lupus Survival |
title_full_unstemmed |
Antimalarial Treatment May Have a Time-Dependent Effect on Lupus Survival |
title_sort |
Antimalarial Treatment May Have a Time-Dependent Effect on Lupus Survival |
author |
Shinjo, Samuel Katsuyuki [UNIFESP] |
author_facet |
Shinjo, Samuel Katsuyuki [UNIFESP] Bonfa, Eloisa Wojdyla, Daniel Borba, Eduardo F. Ramirez, Luis A. Scherbarth, Hugo R. Tavares Brenol, Joao C. Chacon-Diaz, Rosa Neira, Oscar J. Berbotto, Guillermo A. Garcia de La Torre, Ignacio Acevedo-Vazquez, Eduardo M. Massardo, Loreto Barile-Fabris, Leonor A. Caeiro, Francisco Silveira, Luis H. Sato, Emilia Inoue [UNIFESP] Buliubasich, Sandra Alarcon, Graciela S. Pons-Estel, Bernardo A. Grp Latino Amer Estudio Lupus Erit |
author_role |
author |
author2 |
Bonfa, Eloisa Wojdyla, Daniel Borba, Eduardo F. Ramirez, Luis A. Scherbarth, Hugo R. Tavares Brenol, Joao C. Chacon-Diaz, Rosa Neira, Oscar J. Berbotto, Guillermo A. Garcia de La Torre, Ignacio Acevedo-Vazquez, Eduardo M. Massardo, Loreto Barile-Fabris, Leonor A. Caeiro, Francisco Silveira, Luis H. Sato, Emilia Inoue [UNIFESP] Buliubasich, Sandra Alarcon, Graciela S. Pons-Estel, Bernardo A. Grp Latino Amer Estudio Lupus Erit |
author2_role |
author author author author author author author author author author author author author author author author author author author author |
dc.contributor.institution.none.fl_str_mv |
Hosp Prov Rosario Universidade de São Paulo (USP) Univ Nacl Rosario Univ Antioquia Hosp Univ San Vicente de Paul Hosp Interzonal Gen Agudos Dr Oscar Alende Hosp Clin Porto Alegre Univ Fed Rio Grande do Sul Hosp Univ Caracas Hosp Salvador Univ Chile Hosp Escuela Eva Peron Hosp Gen Occidente Secretaria Salud Hosp Nacl Guillermo Almenara Irigoyen Pontificia Univ Catolica Chile Hosp Especialidades Ctr Med Nacl Siglo XXI Hosp Privado Inst Nacl Cardiol Ignacio Chavez Universidade Federal de São Paulo (UNIFESP) Hosp Nacl Clin Univ Alabama |
dc.contributor.author.fl_str_mv |
Shinjo, Samuel Katsuyuki [UNIFESP] Bonfa, Eloisa Wojdyla, Daniel Borba, Eduardo F. Ramirez, Luis A. Scherbarth, Hugo R. Tavares Brenol, Joao C. Chacon-Diaz, Rosa Neira, Oscar J. Berbotto, Guillermo A. Garcia de La Torre, Ignacio Acevedo-Vazquez, Eduardo M. Massardo, Loreto Barile-Fabris, Leonor A. Caeiro, Francisco Silveira, Luis H. Sato, Emilia Inoue [UNIFESP] Buliubasich, Sandra Alarcon, Graciela S. Pons-Estel, Bernardo A. Grp Latino Amer Estudio Lupus Erit |
description |
Objective. To evaluate the beneficial effect of antimalarial treatment on lupus survival in a large, multiethnic, international longitudinal inception cohort.Methods. Socioeconomic and demographic characteristics, clinical manifestations, classification criteria, laboratory findings, and treatment variables were examined in patients with systemic lupus erythematosus (SLE) from the Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohort. the diagnosis of SLE, according to the American College of Rheumatology criteria, was assessed within 2 years of cohort entry. Cause of death was classified as active disease, infection, cardiovascular complications, thrombosis, malignancy, or other cause. Patients were subdivided by antimalarial use, grouped according to those who had received antimalarial drugs for at least 6 consecutive months (user) and those who had received antimalarial drugs for <6 consecutive months or who had never received antimalarial drugs (nonuser).Results. of the 1,480 patients included in the GLADEL cohort, 1,141 (77%) were considered antimalarial users, with a mean duration of drug exposure of 48.5 months (range 6-98 months). Death occurred in 89 patients (6.0%). A lower mortality rate was observed in antimalarial users compared with nonusers (4.4% versus 11.5%; P < 0.001). Seventy patients (6.1%) had received antimalarial drugs for 6-11 months, 146 (12.8%) for 1-2 years, and 925 (81.1%) for >2 years. Mortality rates among users by duration of antimalarial treatment (per 1,000 person-months of followup) were 3.85 (95% confidence interval [95% CI] 1.41-8.37), 2.7 (95% CI 1.41-4.76), and 0.54 (95% CI 0.37-0.77), respectively, while for nonusers, the mortality rate was 3.07 (95% CI 2.18-4.20) (P for trend < 0.001). After adjustment for potential confounders in a Cox regression model, antimalarial use was associated with a 38% reduction in the mortality rate (hazard ratio 0.62, 95% CI 0.39-0.99).Conclusion. Antimalarial drugs were shown to have a protective effect, possibly in a time-dependent manner, on SLE survival. These results suggest that the use of antimalarial treatment should be recommended for patients with lupus. |
publishDate |
2010 |
dc.date.issued.fl_str_mv |
2010-03-01 |
dc.date.accessioned.fl_str_mv |
2016-01-24T13:59:20Z |
dc.date.available.fl_str_mv |
2016-01-24T13:59:20Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Arthritis and Rheumatism. Hoboken: Wiley-liss, v. 62, n. 3, p. 855-862, 2010. |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/32277 http://dx.doi.org/10.1002/art.27300 |
dc.identifier.issn.none.fl_str_mv |
0004-3591 |
dc.identifier.doi.none.fl_str_mv |
10.1002/art.27300 |
dc.identifier.wos.none.fl_str_mv |
WOS:000279432200026 |
identifier_str_mv |
Arthritis and Rheumatism. Hoboken: Wiley-liss, v. 62, n. 3, p. 855-862, 2010. 0004-3591 10.1002/art.27300 WOS:000279432200026 |
url |
http://repositorio.unifesp.br/handle/11600/32277 http://dx.doi.org/10.1002/art.27300 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
Arthritis and Rheumatism |
dc.rights.driver.fl_str_mv |
http://olabout.wiley.com/WileyCDA/Section/id-406071.html info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
http://olabout.wiley.com/WileyCDA/Section/id-406071.html |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
855-862 |
dc.publisher.none.fl_str_mv |
Wiley-Blackwell |
publisher.none.fl_str_mv |
Wiley-Blackwell |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
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UNIFESP |
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UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
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Repositório Institucional da UNIFESP |
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Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
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1802764157274030080 |