Sub-optimal use of anti-malarial therapy for SLE in the Asia Pacific region: observations from the Asia Pacific lupus cohort

Introduction 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. Methods 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 (glucocorticoids (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. Results 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%–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. AM-ever 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.

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Journal
Frontiers in Lupus
Published
2024-11-22
DOI
https://doi.org/10.3389/flupu.2024.1461739
Citations
3
Primary Topic
Systemic Lupus Erythematosus Research
Type
article
Field-Weighted Citation Impact
1.41

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article

Sub-optimal use of anti-malarial therapy for SLE in the Asia Pacific region: observations from the Asia Pacific lupus cohort

Sean O’Neill, Chak Sing Lau, Cherica Tee, Masayoshi Harigai et al.
3 citations
Frontiers in Lupus
Systemic Lupus Erythematosus Research
1.41
article

Sub-optimal use of anti-malarial therapy for SLE in the Asia Pacific region: observations from the Asia Pacific lupus cohort

Sean O’Neill, Chak Sing Lau, Cherica Tee, Masayoshi Harigai, Mandana Nikpour, Shereen Oon, Jun Kikuchi, Eric Francis Morand, Zhanguo Li, Nicola Tugnet, Alberta Hoi, Madelynn Chan, Naoaki Ohkubo, Vera Golder, Yasuhiro Katsumata, Fiona Goldblatt, Yanjie Hao, Worawit Louthrenoo, Jiacai Cho, BMDB Basnayake, Laniyati Hamijoyo, Rangi Kandane‐Rathnayake, Tsutomu Takeuchi, Michael Tee, Aisha Lateef, Sunil Kumar, Yoshiya Tanaka, Shirley Chan, Yi‐Hsing Chen, Sandra Navarra, Leonid Zamora, Sargunan Sockalingam, Zhuoli Zhang, Sang-Cheol Bae, Kristine Ng, Annie Law, Shue Fen Luo, Haihong Yao, Yeong-Jian Jan Wu
article en
3 citations

Abstract

Introduction 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. Methods 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 (glucocorticoids (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. Results 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%–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. AM-ever 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.

Frontiers in LupusVol. 2
University of Santo Tomas Hospital (PH), The University of Sydney (AU), University Malaya Medical Centre (MY), University of Occupational and Environmental Health Japan (JP), Peking University (CN), Keio University (JP), Middlemore Hospital (NZ), Queen Mary Hospital (CN), Liverpool Hospital (AU), North Shore Hospital (NZ), Tan Tock Seng Hospital (SG), Teaching Hospital Kandy (LK), Flinders Medical Centre (AU), Chang Gung Memorial Hospital (TW), University of Malaya (MY), Dr. Hasan Sadikin General Hospital (ID), St Vincent's Hospital Melbourne (AU), Taichung Veterans General Hospital (TW), Greenlane Clinical Centre (NZ), Monash Health (AU), Peking University People's Hospital (CN), Peking University First Hospital (CN), Tokyo Women's Medical University (JP), Hanyang University Seoul Hospital (KR), Woodlands Health Campus (SG), National University Hospital (SG), Sanno Medical Center (JP), Chiang Mai University (TH), Monash University (AU), University of the Philippines Manila (PH), Saitama Medical University (JP), University of Hong Kong (HK), Padjadjaran University (ID)
Bristol-Myers Squibb, Eli Lilly and Company, AstraZeneca, National Research Foundation, National Research Foundation of Korea, Kementerian Pendidikan, EMD Serono
Partnerships for the goals
Openalex Percentile: Top 17%
Systemic Lupus Erythematosus Research
1.41
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