{"title":"Effect of hydroxychloroquine on pregnancy outcome in patients with SLE: a systematic review and meta-analysis.","authors":"Qingmiao Zhu, Jiayu Wang, Qice Sun, Zhijun Xie, Rongqun Li, Zi Yang, Ziyu Song, Kepeng Yang, Ting Zhao","doi":"10.1136/lupus-2024-001239","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Hydroxychloroquine (HCQ) is an antimalarial drug employed in the treatment of systemic lupus erythematosus (SLE). Prior studies reported inconsistent results regarding the association between HCQ use during pregnancy and adverse pregnancy outcomes. This study aimed to evaluate the impact of HCQ on pregnancy-related outcomes in women with SLE.</p><p><strong>Methods: </strong>We conducted a systematic search for studies associating pregnancy outcomes with HCQ use in PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang database and VIP from inception to 22 September 2022. Random or fixed effect models were used to estimate the pooled effect based on I<sup>2</sup> measurement of heterogeneity.</p><p><strong>Results: </strong>Twenty-one studies were included, encompassing 929 and 1031 patients in HCQ and non-HCQ groups, respectively. We found that HCQ use was significantly associated with reduced risks of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores (second trimester: mean difference (MD) -1.80, 95% CI -2.46 to -1.13; third trimester: MD -2.30, 95% CI -3.31 to -1.29), flare (OR 0.57, 95% CI 0.33 to 0.97), preterm birth (OR 0.57, 95% CI 0.46 to 0.72), intrauterine growth retardation (IUGR) (OR 0.48, 95% CI 0.31 to 0.72), gestational hypertension (OR 0.19, 95% CI 0.08 to 0.42), pre-eclampsia (OR 0.46, 95% CI 0.29 to 0.72). In contrast, a positive correlation was observed between full-term birth and HCQ use (OR 2.01, 95% CI 1.52 to 2.65). However, the result for disease flare exhibited high heterogeneity (p=0.01, I<sup>2</sup>=59%). In addition, publication bias was detected in the meta-analysis of full-term birth using the Egger's test.</p><p><strong>Conclusions: </strong>This meta-analysis offers a comprehensive assessment of the relationship between disease activity, pregnancy-related outcomes and HCQ use, providing supportive evidence for the therapeutic effectiveness of HCQ in pregnant women with SLE.</p><p><strong>Prospero registration number: </strong>CRD42022374468.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"11 2","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529578/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lupus Science & Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/lupus-2024-001239","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
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Abstract
Objective: Hydroxychloroquine (HCQ) is an antimalarial drug employed in the treatment of systemic lupus erythematosus (SLE). Prior studies reported inconsistent results regarding the association between HCQ use during pregnancy and adverse pregnancy outcomes. This study aimed to evaluate the impact of HCQ on pregnancy-related outcomes in women with SLE.
Methods: We conducted a systematic search for studies associating pregnancy outcomes with HCQ use in PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang database and VIP from inception to 22 September 2022. Random or fixed effect models were used to estimate the pooled effect based on I2 measurement of heterogeneity.
Results: Twenty-one studies were included, encompassing 929 and 1031 patients in HCQ and non-HCQ groups, respectively. We found that HCQ use was significantly associated with reduced risks of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores (second trimester: mean difference (MD) -1.80, 95% CI -2.46 to -1.13; third trimester: MD -2.30, 95% CI -3.31 to -1.29), flare (OR 0.57, 95% CI 0.33 to 0.97), preterm birth (OR 0.57, 95% CI 0.46 to 0.72), intrauterine growth retardation (IUGR) (OR 0.48, 95% CI 0.31 to 0.72), gestational hypertension (OR 0.19, 95% CI 0.08 to 0.42), pre-eclampsia (OR 0.46, 95% CI 0.29 to 0.72). In contrast, a positive correlation was observed between full-term birth and HCQ use (OR 2.01, 95% CI 1.52 to 2.65). However, the result for disease flare exhibited high heterogeneity (p=0.01, I2=59%). In addition, publication bias was detected in the meta-analysis of full-term birth using the Egger's test.
Conclusions: This meta-analysis offers a comprehensive assessment of the relationship between disease activity, pregnancy-related outcomes and HCQ use, providing supportive evidence for the therapeutic effectiveness of HCQ in pregnant women with SLE.
目的：羟氯喹（HCQ）是一种用于治疗系统性红斑狼疮（SLE）的抗疟疾药物。先前的研究报告显示，孕期使用 HCQ 与不良妊娠结局之间的关联结果并不一致。本研究旨在评估 HCQ 对系统性红斑狼疮妇女妊娠相关结局的影响：我们在PubMed、EMBASE、Cochrane Library、Web of Science、CNKI、万方数据库和VIP中对妊娠结局与HCQ使用相关的研究进行了系统检索，检索时间从开始至2022年9月22日。根据异质性的 I2 测量值，采用随机或固定效应模型估算汇总效应：结果：共纳入21项研究，HCQ组和非HCQ组分别有929名和1031名患者。我们发现，使用HCQ与系统性红斑狼疮疾病活动指数（SLEDAI）评分风险的降低有显著相关性（第二孕期：平均差（MD）-1.80，95% CI -2.46至-1.13；第三孕期：MD-2.30，95% CI -2.46至-1.13）：MD-2.30，95% CI -3.31至-1.29）、疾病复发（OR 0.57，95% CI 0.33至0.97）、早产（OR 0.57，95% CI 0.46至0.72）、宫内发育迟缓（IUGR）（OR 0.48，95% CI 0.31至0.72）、妊娠高血压（OR 0.19，95% CI 0.08至0.42）、子痫前期（OR 0.46，95% CI 0.29至0.72）。相比之下，足月分娩与使用 HCQ 呈正相关（OR 2.01，95% CI 1.52 至 2.65）。然而，疾病复发的结果显示出高度异质性（P=0.01，I2=59%）。此外，在使用Egger检验对足月儿进行的荟萃分析中发现了发表偏倚：这项荟萃分析全面评估了疾病活动、妊娠相关结局和使用HCQ之间的关系，为HCQ对系统性红斑狼疮孕妇的治疗效果提供了支持性证据：CRD42022374468。
期刊介绍：
Lupus Science & Medicine is a global, peer reviewed, open access online journal that provides a central point for publication of basic, clinical, translational, and epidemiological studies of all aspects of lupus and related diseases. It is the first lupus-specific open access journal in the world and was developed in response to the need for a barrier-free forum for publication of groundbreaking studies in lupus. The journal publishes research on lupus from fields including, but not limited to: rheumatology, dermatology, nephrology, immunology, pediatrics, cardiology, hepatology, pulmonology, obstetrics and gynecology, and psychiatry.
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