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Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis: LXV, data from a multiethnic US cohort
Arthritis Care and Research , 06/03/09

Pons-Estel GJ et al. – Study demonstrates that after adjusting for possible confounding factors, the protective effect of hydroxychloroquine in retarding renal damage occurrence in systemic lupus erythematosus is still evident.

• Aim was to assess whether hydroxychloroquine can delay renal damage development in lupus nephritis pts
• 256 pts; a multiethnic cohort of African Americans, Hispanics, and Caucasians; age: ≥16 yrs; disease duration: ≤5 yrs at baseline (T0)
• Renal damage was defined as ≥1 of the following lasting at least 6 mo:
  • estimated/measured glomerular filtration rate <50%
  • 24-hour proteinuria ≥3.5 gm and/or
  • end-stage renal disease, regardless of dialysis or transplantation
• Pts with renal damage before T0 were excluded (n=53)
• Association between hydroxychloroquine use and renal damage was estimated using Cox proportional regression analyses adjusting for potential confounders
• Kaplan-Meier survival curves based on hydroxychloroquine intake or the WHO class glomerulonephritis were also derived

• 63/203 (31.0%) pts included developed renal damage over a mean disease duration of 5.2 yrs
• Most frequent renal damage domain item was proteinuria
• Pts who received hydroxychloroquine (79.3%) exhibited:
  • a lower frequency of WHO class IV glomerulonephritis
  • had lower disease activity, and
  • received lower glucocorticoid doses
    than those who did not take hydroxychloroquine
• After adjusting for confounders, hydroxychloroquine was protective of renal damage occurrence in full and reduced models
• Omitting proteinuria provided comparable results
• Cumulative probability of renal damage occurrence was higher in those:
  • who did not take hydroxychloroquine and
  • those classified as WHO class IV glomerulonephritis

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