Protective effect of antimalarials on the most frequently affected damage domains in SLE: Data from a multiethnic Latin American cohort

ObjectiveTo assess the effect of antimalarials (AMs) on overall damage and on its most frequently affected domains, as measured by the Systemic Lupus International Collaborating Clinics Damage Index (SDI) in patients from the GLADEL cohort.MethodsNew damage was defined as a ≥1 point increase in SDI since cohort entry. AMs users were those who received AMs for at least 6 months after entering the cohort. AMs users and non-users were matched for age, sex, ethnicity, and baseline SDI using stratified random sampling. Two comparisons were carried out: patients with and without new damage, and AM users versus non-users. Propensity score matching was used to determine the effect of AM use on the most frequently affected damage domains.ResultsA total of 850 patients were included; 419 (49.3%) were AM users and 431 (50.7%) non-users. During a median follow-up of 48.5 (IQR 19.3, 69.0) months, 472 (55.5%) developed damage. The most affected domains were skin (18.4%), renal (14.6%), neuropsychiatric (10.8%), musculoskeletal (6.9%), and cardiovascular (4.5%). AMs use was associated with a lower proportion of patients accruing damage at follow-up (170 [40.6%] vs 208 [48.3%]; <i>p</i> = .028). AMs were protective against overall damage (HR 0.7, 95% CI [0.5-0.9]; <i>p</i> = .002), renal (HR 0.4, 95% CI [0.3-0.6]; <i>p</i> < .001), and neuropsychiatric damage (HR 0.5, 95% CI [0.3-0.9]; <i>p</i> = .022).ConclusionAM use is independently associated with a lower probability of overall, renal, and neuropsychiatric damage accrual. These findings support early and sustained AM treatment in lupus patients, unless contraindicated.

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Journal
Lupus
Published
2026-02-25
DOI
https://doi.org/10.1177/09612033261429132
Primary Topic
Systemic Lupus Erythematosus Research
Type
article
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article

Protective effect of antimalarials on the most frequently affected damage domains in SLE: Data from a multiethnic Latin American cohort

N. Da Silva, Marina Scolnik, Myrna Cardiel, Guillermo Berbotto et al.
Lupus
Systemic Lupus Erythematosus Research
article

Protective effect of antimalarials on the most frequently affected damage domains in SLE: Data from a multiethnic Latin American cohort

N. Da Silva, Marina Scolnik, Myrna Cardiel, Guillermo Berbotto, María Josefina Sauza del Pozo, Ernesto Zavala-Flores, Cristina Drenkard, Judith Sarano, M. Sacnún, Óscar Neira, Amigo Mc, Rosana Quintana, Eduardo Ferreira Borba, Luís J. Catoggio, Marlene Guibert-Toledano, Luis Alonso González, DANIEL M. WOJDYLA, G. Marañón Vásquez, Pascual-Ramos, Luis H. Silveira, EI Sato, Victor R. Pimentel-Quiroz, Rosa María Serrano, Loreto Massardo, Joao C. Tavares Brenol, Ignacio García de la Torre, Ricardo Xavier, María Inés Segami, Eduardo M. Acevedo-Vásquez, Guillermo J. Pons-Estel, Eloisa Bonfa, Francisco Caeiro, Mercedes García, Rosa Chacón-Díaz, Graciela S. Alarcón, Alejandro Alvarellos, Lilian Costallat, Leonor Barile
article en

Abstract

ObjectiveTo assess the effect of antimalarials (AMs) on overall damage and on its most frequently affected domains, as measured by the Systemic Lupus International Collaborating Clinics Damage Index (SDI) in patients from the GLADEL cohort.MethodsNew damage was defined as a ≥1 point increase in SDI since cohort entry. AMs users were those who received AMs for at least 6 months after entering the cohort. AMs users and non-users were matched for age, sex, ethnicity, and baseline SDI using stratified random sampling. Two comparisons were carried out: patients with and without new damage, and AM users versus non-users. Propensity score matching was used to determine the effect of AM use on the most frequently affected damage domains.ResultsA total of 850 patients were included; 419 (49.3%) were AM users and 431 (50.7%) non-users. During a median follow-up of 48.5 (IQR 19.3, 69.0) months, 472 (55.5%) developed damage. The most affected domains were skin (18.4%), renal (14.6%), neuropsychiatric (10.8%), musculoskeletal (6.9%), and cardiovascular (4.5%). AMs use was associated with a lower proportion of patients accruing damage at follow-up (170 [40.6%] vs 208 [48.3%]; <i>p</i> = .028). AMs were protective against overall damage (HR 0.7, 95% CI [0.5-0.9]; <i>p</i> = .002), renal (HR 0.4, 95% CI [0.3-0.6]; <i>p</i> < .001), and neuropsychiatric damage (HR 0.5, 95% CI [0.3-0.9]; <i>p</i> = .022).ConclusionAM use is independently associated with a lower probability of overall, renal, and neuropsychiatric damage accrual. These findings support early and sustained AM treatment in lupus patients, unless contraindicated.

Lupus
Royal College of Emergency Medicine (GB), Emory and Henry College (US), Universidade Estadual de Campinas (UNICAMP) (BR), Universidad Peruana Cayetano Heredia (PE), National University of General San Martín (AR), Universidad Científica del Sur (PE), Hospital Italiano de Buenos Aires (AR), San Sebastián University (CL), University of Alabama at Birmingham (US), Universidad de Antioquia (CO), National University of Rosario (AR), Secretaria de Salud (MX), Hospital Clínico Universitario de Caracas (VE), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (MX), Centro Rosarino de Estudios Perinatales (AR), Universidad de Morelia (MX), Instituto Nacional de Cardiologia (BR), Hospital Angeles Pedregal (MX), Secretaria de Salud (HN), EsSALUD (PE), Centro Médico ABC (MX), Hospital de Especialidades (MX), Hospital Universitário da Universidade de São Paulo (BR), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (BR), Hospital Privado (AR), Instituto Nacional de Cardiología (MX), Universidad del Pedregal (MX), Universidade Federal de Goiás (BR), Universidade Federal do Estado do Rio de Janeiro (BR), Universidade Federal de São Paulo (BR)
Openalex Percentile: Top 45%
Systemic Lupus Erythematosus Research
DOISourceOpenAlex
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