Hydroxychloroquine Improves Low Complement Levels

IF 3.7 2区 医学 Q1 RHEUMATOLOGY Arthritis Care & Research Pub Date : 2024-06-03 DOI:10.1002/acr.25381
Rebecca Jacobson, Daniel Goldman, Andrea Fava, Laurence Magder, Michelle Petri
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Abstract

Objective

Having a low complement level is associated with clinical systemic lupus erythematosus (SLE) disease activity and future organ damage. We studied the association of hydroxychloroquine (HCQ) whole blood levels with changes in complement level.

Methods

We performed two analyses on data prospectively collected from an SLE cohort. In the first (a “new starts on HCQ” analysis), we compared changes in complement level between those starting HCQ and those not starting it. The second analysis evaluated the association between HCQ whole blood levels and low complement level in all cohort visits using conditional logistic regression.

Results

In the “new starts on HCQ” analysis, a higher percentage of patients starting HCQ (as reflected in HCQ blood levels >50) experienced a normalization of C4 level compared to those not starting HCQ (23 of 57 [40%] vs. 9 of 56 [13%]; P = 0.011), as well as a significantly greater increase in both C3 and C4 level (P = 0.048 and P = 0.017, respectively). In the “all cohort visits” analysis, there was a statistically significant higher probability of having normal C4 levels in visits with higher HCQ whole blood levels (odds ratio 1.8–2.6 depending on the levels). This relationship was most pronounced for whole blood HCQ levels of 200 ng/mL or more.

Conclusion

We observed significant improvement in complement levels when HCQ was started and among those with higher whole blood levels of HCQ, particularly with respect to C4. Modulating the pathogenic mechanisms that lead to complement consumption may be one mode by which HCQ prevents poor outcomes in SLE.

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羟氯喹可改善低补体水平。
目的:低补体与系统性红斑狼疮(SLE)的临床疾病活动和未来的器官损伤有关。我们研究了羟氯喹(HCQ)全血水平与补体变化的关系:我们对从一个系统性红斑狼疮队列中收集的前瞻性数据进行了两项分析。在第一项分析("新开始使用 HCQ "分析)中,我们比较了开始使用羟氯喹者和未开始使用羟氯喹者的补体变化。第二项分析采用条件逻辑回归法评估了羟氯喹全血水平与所有队列中低补体之间的关联:在 "新开始使用 HCQ "分析中,与未开始使用羟氯喹的患者相比,有更高比例的患者(反映在 HCQ 血液水平>50)C4 恢复正常(23/57 (40%) vs. 9/56 (13%),p=0.011),C3 和 C4 也显著增加(分别为 p=0.048 和 p=0.017)。在 "所有队列就诊 "分析中,在羟氯喹全血水平较高的就诊者中,C4水平正常的概率具有显著的统计学意义(OR 1.8 至 2.6,视水平而定)。这种关系在全血羟氯喹水平达到或超过 200ng/ml 时最为明显:我们观察到,在开始使用羟氯喹时,以及在羟氯喹全血水平较高的人群中,补体水平有明显改善,尤其是在 C4 方面。调节导致补体消耗的致病机制可能是羟氯喹预防系统性红斑狼疮不良预后的一种模式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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