RI-MUHC researchers identify factors associated with poor outcomes for lupus patients
Source: RI-MUHC

Lupus has been called the “disease with a thousand faces,” given how greatly its symptoms can vary from person to person. A chronic autoimmune disease affecting more than one in 1,000 Canadians, lupus is commonly treated on a worldwide basis using the drug hydroxychloroquine (HCQ). Sustained use of this drug can greatly reduce disease flares.

In a new study in the journal Arthritis Care and Research, researchers from the Research Institute of the McGill University Health Centre (RI-MUHC) have addressed the question of tapering or discontinuing use of HCQ in lupus treatment. Specifically, the team sought to identify demographic and clinical factors associated with poor outcomes for Systemic Lupus Erythematosus (SLE) patients after tapering or discontinuing HCQ treatment.

Dr. Sasha Bernatsky, senior scientist at the RI-MUHC and postdoctoral fellow and lead author Celline Brasil, PhD.

Led by Sasha Bernatsky, MD, PhD, James McGill Professor of Medicine at McGill University, a physician in the Division of Rheumatology, MUHC, and senior scientist at the RI-MUHC, the study followed 1,344 patients from five Canadian SLE cohorts between 1999 and 2019. The authors identified patients receiving a lower dose or discontinuing HCQ during follow-up and evaluated the flare rate after HCQ was disrupted. They identified a third group of patients—those who maintained HCQ—for comparison purposes.

“We observed that some subgroups of patients, including non-Caucasians, those aged 25 years old or younger at lupus diagnosis, and those with active disease, are at higher risk of flaring after HCQ is disrupted,” says Dr. Bernatsky, a member of the Infectious Diseases and Immunity in Global Health Program at the RI-MUHC, where she conducts research at the Centre for Outcomes Research and Evaluation. “Knowing the predictors of unsuccessful hydroxychloroquine tapering and discontinuation is the first step in understanding how treatment maybe be personalized for individual patients.”

“Our findings took on new importance with the COVID-19 pandemic, since HCQ was added to the FDA drug shortage list,” says Celline Brasil, PhD, postdoctoral fellow at the RI-MUHC and first author of the study. “Patients reducing or stopping HCQ had significantly higher flare rates than those maintaining the drug and a shortage of HCQ inevitably impacts the SLE patients who rely on this medication.”

The identification of multiple demographic and clinical predictors of poor outcomes after HCQ taper/discontinuation may be useful in monitoring for flares when HCQ tapering or stopping is needed, as well as in personalizing decisions for SLE patients (and their physicians) around medication de-escalation or maintenance.

Adds Dr. Bernatsky, “As a rheumatologist treating SLE patients for over 20 years, I know firsthand the real and urgent need for real-world data to inform decision-making. We hope that our paper will be instrumental in answering some questions regarding tapering or stopping HCQ and will inspire more research to support individual decision-making and personalized treatment.”

About the study:

Celline C. Almeida‐Brasil, Christian A. Pineau, Evelyne Vinet, John G. Hanly, Christine A. Peschken, Ann E. Clarke, Paul R. Fortin, Michal Abrahamowicz, Sasha Bernatsky. Predictors of unsuccessful hydroxychloroquine tapering and discontinuation: Can we personalize decision‐making in systemic lupus treatment? Journal of Arthritis Care and Research. Epub ahead of print 26 December 2020. https://doi.org/10.1002/acr.24548

The authors gratefully acknowledge funding from the Canadian Institutes of Health Research (CIHR) and the Fonds de Recherche du Québec – Santé (FRQS).

To learn more about fundraising and advocacy, visit Lupus Canada.

January 26, 2021