AUTHOR=Hidekawa Chiharu , Yoshimi Ryusuke , Saigusa Yusuke , Tamura Jun , Kojitani Noriko , Suzuki Naoki , Sakurai Natsuki , Yoshioka Yuji , Sugiyama-Kawahara Yumiko , Kunishita Yosuke , Kishimoto Daiga , Higashitani Kana , Sato Yuichiro , Komiya Takaaki , Nagai Hideto , Hamada Naoki , Maeda Ayaka , Tsuchida Naomi , Hirahara Lisa , Soejima Yutaro , Takase-Minegishi Kaoru , Kirino Yohei , Yajima Nobuyuki , Sada Ken-ei , Miyawaki Yoshia , Ichinose Kunihiro , Ohno Shigeru , Kajiyama Hiroshi , Sato Shuzo , Shimojima Yasuhiro , Fujiwara Michio , Nakajima Hideaki TITLE=Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry JOURNAL=Frontiers in Immunology VOLUME=14 YEAR=2023 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2023.1227403 DOI=10.3389/fimmu.2023.1227403 ISSN=1664-3224 ABSTRACT=Objectives

Infection is a leading cause of death in patients with systemic lupus erythematosus (SLE). Alt hough hydroxychloroquine (HCQ) has been reported to inhibit infection, evidence from Asian populations remains insufficient. We investigated this effect in Japanese SLE patients.

Methods

Data from the Lupus Registry of Nationwide Institutions were used in this study. The patients were ≥20 years old and met the American College of Rheumatology (ACR) classification criteria revised in 1997. We defined “severe infections” as those requiring hospitalization. We analyzed the HCQ’s effect on infection suppression using a generalized estimating equation (GEE) logistic regression model as the primary endpoint and performed a survival analysis for the duration until the first severe infection.

Results

Data from 925 patients were used (median age, 45 [interquartile range 35–57] years; female, 88.1%). GEE analysis revealed that severe infections were significantly associated with glucocorticoid dose (odds ratio [OR] 1.968 [95% confidence interval, 1.379–2.810], p<0.001), immunosuppressants (OR 1.561 [1.025–2.380], p=0.038), and baseline age (OR 1.043 [1.027–1.060], p<0.001). HCQ tended to suppress severe infections, although not significantly (OR 0.590 [0.329–1.058], p=0.077). Survival time analysis revealed a lower incidence of severe infections in the HCQ group than in the non-HCQ group (p<0.001). In a Cox proportional hazards model, baseline age (hazard ratio [HR] 1.029 [1.009–1.050], p=0.005) and HCQ (HR 0.322 [0.142–0.728], p=0.006) were significantly related to incidence.

Conclusion

HCQ may help extend the time until the occurrence of infection complications and tends to decrease infection rates.