Rangi Kandane-Rathnayake ^1* Alberta Hoi ^1,2 Worawit Louthrenoo ³ Yi-Hsing Chen ⁴ Jiacai Cho ⁵ Aisha lateef ⁶ Laniyati Hamijoyo ^7,8 Shirley Chan ⁹ Shue Fen Luo ¹⁰ Yeong-Jian Wu ¹¹ Sandra Navarra ¹² Leonid Zamora ¹² Zhanguo Li ¹³ Haihong Yao ¹³ Sargunan Sockalingam ¹⁴ Yasuhiro Katsumata ¹⁵ Masayoshi Harigai ^15,16 Yanjie Hao ^17,18 Zhuoli Zhang ¹⁷ BMDB Basnayake ¹⁹ Madelynn Chan ²⁰ Jun Kikuchi ²¹ Tsutomu Takeuchi ^21,22 Shereen Oon ¹⁸ Sang-Cheol Bae ^23,24,25 Sean O'Neill ^26,27 Fiona Goldblatt ²⁸ Kristine Ng ²⁹ Annie H. Law ³⁰ Nicola Tugnet ³¹ Sunil Kumar ³² Naoaki Ohkubo ³³ Michael L. Tee ³⁴ Cherica Tee ³⁴ Yoshiya Tanaka ³³ Chak Lau ⁹ Vera Golder ^1,2 Mandana Nikpour ^18,35 Eric F. Morand ^1,2

• ¹ Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia, Melbourne, Australia
• ² Rheumatology Department, Monash Health, Clayton, Victoria, Australia, Melbourne, Australia
• ³ Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
• ⁴ Division of Allergy and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
• ⁵ Rheumatology Division, National University of Singapore, Singapore, Singapore
• ⁶ Department of Medicine, Woodlands Health, Singapore, Singapore
• ⁷ Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, West Java, Indonesia
• ⁸ Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
• ⁹ Department of Medicine, Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong, SAR China
• ¹⁰ Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital,, Taipei, Taiwan
• ¹¹ Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital,, Keelung, Republic of China, Taiwan
• ¹² Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
• ¹³ Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, Beijing Municipality, China
• ¹⁴ Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
• ¹⁵ Institute of Rheumatology, Tokyo Women's Medical University,, Tokyo, Japan
• ¹⁶ Department of Rheumatology, Sanno Hospital, Tokyo, Japan
• ¹⁷ Division of Rheumatology, First Hospital, Peking University, Beijing, Beijing Municipality, China
• ¹⁸ Department of Rheumatology, St Vincent’s Hospital,, Melbourne, Victoria, Australia
• ¹⁹ Department of Nephrology, Teaching Hospital Kandy,, Kandy, Sri Lanka
• ²⁰ Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore
• ²¹ Department of Internal Medicine, School of Medicine, Keio University, Shinjyuku, Japan
• ²² Department of Rheumatology and Applied Immunology, Saitama Medical University,, Saitama, Japan
• ²³ Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
• ²⁴ Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
• ²⁵ Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Republic of Korea
• ²⁶ Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
• ²⁷ Department of Medicine, University of Sydney, Sydney, NSW, Australia
• ²⁸ Department of Rheumatology, Flinders Medical Centre, Adelaide, Australia
• ²⁹ Department of Medicine, North Shore Hospital, Auckland, New Zealand
• ³⁰ Asia Arthritis and Rheumatology Centre,, Singapore, Singapore
• ³¹ Department of Rheumatology, Greenlane Clinical Centre,, Auckland, New Zealand
• ³² Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
• ³³ The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
• ³⁴ University of the Philippines Manila, Manila, Philippines
• ³⁵ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

The guidelines for management of patients with systemic lupus erythematosus (SLE) recommend the use of anti-malarial (AM) drugs (commonly hydroxychloroquine (HCQ)) in all patients, unless contraindicated. We evaluated the prevalence of AM use in patients with SLE in countries across the Asia Pacific region.We used data from the Asia Pacific Lupus Collaboration (APLC) cohort, collected prospectively from SLE patients meeting ACR or/and SLICC criteria, between 2013 and 2020. Demographic factors were collected at enrolment; disease activity indicators (SLEDAI-2K, PGA, SFI) and medication (glucocorticoid (GC), immunosuppressants (IS) and AM) details were captured at enrolment and at routine visits, and organ damage was assessed at enrolment and at annual visits using SLICC/ACR Damage Index. We examined medication use in relation to clinical and serological activity, defined based on SLEDAI-2K.We analyzed 4,086 patients and 41,653 visits of data; 3,222 (79%) patients used AM at least once during observation (AM-ever users), but this proportion varied significantly between countries (31% to 95%). Overall, the total number of visits with AM use was 27,474 (66%). AM-never users were older and had lower disease activity at study enrolment when compared with AM-ever users. AMever users had lower GC and IS exposure; experienced fewer severe flares, and less organ damage. Discussion:AM use was suboptimal and varied significantly across countries, highlighting disparities between current practice and SLE management guidelines. This study further reiterates that patients who used AM during the study period had lower exposure to GC and IS and experienced fewer severe flares and organ damage.