Evidence-based international guidelines for the treatment of systemic lupus erythematosus (SLE) recommend treatment with antimalarials (AMs) for all patients with SLE irrespective of disease activity. Only a few studies have investigated the use of AMs among newly diagnosed patients with SLE.
Objectives
The objective of this paper is to analyze prescription patterns of AMs in newly diagnosed SLE patients in Denmark from 2000 to 2011.
Methods
Using the Danish Prescription Register (DNPR), we conducted a nationwide cohort study including all patients with a first-time diagnosis of SLE (the Danish National Registry of Patients (NPR)). We used Kaplan-Meier estimates to compute the cumulative probability of starting AM treatment within a year and Cox regression analysis to compare time to treatment between patient groups.
Results
AMs were prescribed to 37.7% of the newly diagnosed SLE patients within the first year of follow-up. Approximately 20% did not receive any medical treatment. Women were more likely than men to start AM (adjusted HR of 1.28 (95% CI 1.08–1.52)). Patients diagnosed with SLE between 2005 and 2011 were more likely to start treatment than patients diagnosed between 2000 and 2004 (HR of 1.21 (95% CI 1.07–1.36)). Patients with renal disease were less likely to start AM treatment than patients without this condition (adjusted HR of 0.50 (95% CI 0.36–0.68)). Current users of corticosteroids were more likely to start AM treatment than non-users (adjusted HR 1.81 (95% CI 1.59–2.06)).
Conclusion
Time to start of AM treatment following SLE diagnosis could be further reduced, especially among patients with renal disease. However, our results showed that treatment practice in recent years has changed toward initiating AM treatment earlier.
LaustrupHVossAGreenAJunkerP. Occurrence of systemic lupus erythematosus in a Danish community: An 8-year prospective study. Scand J Rheumatol2009; 38: 128–132.
2.
LerangKGilboeIGarenTThelleDSGranJT. High incidence and prevalence of systemic lupus erythematosus in Norway. Lupus2012; 21: 1362–1369.
3.
FeldmanCHHirakiLTLiuJ. Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000–2004. Arthritis Rheum2013; 65: 753–763.
4.
VossALaustrupHHjelmborgJJunkerP. Survival in systemic lupus erythematosus, 1995–2010. A prospective study in a Danish community. Lupus2013; 22: 1185–1191.
NikpourMUrowitzMBGladmanDD. Epidemiology of atherosclerosis in systemic lupus erythematosus. Curr Rheumatol Rep2009; 11: 248–254.
7.
HakAEKarlsonEWFeskanichDStampferMJCostenbaderKH. Systemic lupus erythematosus and the risk of cardiovascular disease: Results from the Nurses’ Health Study. Arthritis Rheum2009; 61: 1396–1402.
8.
TangCGodfreyTStawellRNikpourM. Hydroxychloroquine in lupus: Emerging evidence supporting multiple beneficial effects. Intern Med J2012; 42: 968–978.
9.
MerrellMShulmanLE. Determination of prognosis in chronic disease, illustrated by systemic lupus erythematosus. J Chronic Dis1955; 1: 12–32.
10.
CerveraRKhamashtaMAFontJ. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: A comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore)2003; 82: 299–308.
11.
LeeSJSilvermanEBargmanJM. The role of antimalarial agents in the treatment of SLE and lupus nephritis. Nat Rev Nephrol2011; 7: 718–729.
12.
TsakonasEJosephLEsdaileJM. A long-term study of hydroxychloroquine withdrawal on exacerbations in systemic lupus erythematosus. The Canadian Hydroxychloroquine Study Group. Lupus1998; 7: 80–85.
13.
BertsiasGIoannidisJPABoletisJ. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis2008; 67: 195–205.
14.
Ruiz-IrastorzaGRamos-CasalsMBrito-ZeronPKhamashtaMA. Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: A systematic review. Ann Rheum Dis2010; 69: 20–28.
15.
BertsiasGKTektonidouMAmouraZ. Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis2012; 71: 1771–1782.
16.
HahnBHMcMahonMAWilkinsonA. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken)2012; 64: 797–808.
PedersenCBGøtzscheHMøllerJOMortensenPB. The Danish Civil Registration System. A cohort of eight million persons. Dan Med Bull2006; 53: 441–449.
19.
AndersenTFMadsenMJørgensenJMellemkjoerLOlsenJH. The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull1999; 46: 263–268.
CharlsonMEPompeiPAlesKLMacKenzieCR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis1987; 40: 373–383.
22.
JönsenAClarkeAEJosephL. Association of the Charlson Comorbidity Index with mortality in systemic lupus erythematosus. Arthritis Care Res (Hoboken)2011; 63: 1233–1237.
23.
de GrootVBeckermanHLankhorstGJBouterLM. How to measure comorbidity. A critical review of available methods. J Clin Epidemiol2003; 56: 221–229.
24.
JuelKHelweg-LarsenK. The Danish registers of causes of death. Dan Med Bull1999; 46: 354–357.
25.
SuissaS. Immortal time bias in observational studies of drug effects. Pharmacoepidemiol Drug Saf2007; 16: 241–249.
26.
FesslerBJAlarcónGSMcGwinGJr. Systemic lupus erythematosus in three ethnic groups: XVI. Association of hydroxychloroquine use with reduced risk of damage accrual. Arthritis Rheum2005; 52: 1473–1480.
27.
SchmajukGYazdanyJTrupinLYelinE. Hydroxychloroquine treatment in a community-based cohort of patients with systemic lupus erythematosus. Arthritis Care Res (Hoboken)2010; 62: 386–392.
28.
MokCCTangSSToCHPetriM. Incidence and risk factors of thromboembolism in systemic lupus erythematosus: A comparison of three ethnic groups. Arthritis Rheum2005; 52: 2774–2782.
29.
TolozaSMUribeAGMcGwinGJr. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXIII. Baseline predictors of vascular events. Arthritis Rheum2004; 50: 3947–3957.
30.
MeinãoIMSatoEIAndradeLEFerrazMBAtraE. Controlled trial with chloroquine diphosphate in systemic lupus erythematosus. Lupus1996; 5: 237–241.
31.
WilliamsHJEggerMJSingerJZ. Comparison of hydroxychloroquine and placebo in the treatment of the arthropathy of mild systemic lupus erythematosus. J Rheumatol1994; 21: 1457–1462.
Costedoat-ChalumeauNAmouraZHulotJS. Low blood concentration of hydroxychloroquine is a marker for and predictor of disease exacerbations in patients with systemic lupus erythematosus. Arthritis Rheum2006; 54: 3284–3290.
34.
AlarcónGSMcGwinGBertoliAM. Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus: Data from LUMINA, a multiethnic US cohort (LUMINA L). Ann Rheum Dis2007; 66: 1168–1172.
35.
SisóARamos-CasalsMBovéA. Previous antimalarial therapy in patients diagnosed with lupus nephritis: Influence on outcomes and survival. Lupus2008; 17: 281–288.
36.
Ruiz-IrastorzaGEgurbideMPijoanJ. Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus. Lupus2006; 15: 577–583.
37.
FesslerBJAlarcónGSMcGwinGJr. Systemic lupus erythematosus in three ethnic groups: XVI. Association of hydroxychloroquine use with reduced risk of damage accrual. Arthritis Rheum2005; 52: 1473–1480.
38.
KitsonALRycroft-MaloneJHarveyGMcCormackBSeersKTitchenA. Evaluating the successful implementation of evidence into practice using the PARiHS framework: Theoretical and practical challenges. Implement Sci2008; 3: 1–1.
39.
SokkaT. Increases in use of methotrexate since the 1980s. Clin Exp Rheumatol2010; 28(5 Suppl 61): S13–S20.
40.
BernatskySPeschkenCFortinPR. Medication use in systemic lupus erythematosus. J Rheumatol2011; 38: 271–274.
41.
VossAGreenAJunkerP. Systemic lupus erythematosus in Denmark: Clinical and epidemiological characterization of a county-based cohort. Scand J Rheumatol1998; 27: 98–105.
42.
EilertsenGOBecker-MerokANossentJC. The influence of the 1997 updated classification criteria for systemic lupus erythematosus: Epidemiology, disease presentation, and patient management. J Rheumatol2009; 36: 552–559.
