Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/ro-antibody - Associated cardiac manifestations of neonatal lupus

Peter M. Izmirly, Nathalie Costedoat-Chalumeau, Cecilia N. Pisoni, Munther A. Khamashta, Mimi Y. Kim, Amit Saxena, Deborah Friedman, Carolina Llanos, Jean Charles Piette, Jill P. Buyon

Research output: Contribution to journalArticlepeer-review

204 Scopus citations

Abstract

Background-A recent case-control study suggested a benefit of hydroxychloroquine (HCQ) in lowering the risk of cardiac manifestations of neonatal lupus (cardiac-NL) in pregnancies of anti-SSA/Ro-positive patients with systemic lupus erythematosus. A historical cohort assembled from 3 international databases was used to evaluate whether HCQ reduces the nearly 10-fold increase in risk of recurrence of cardiac-NL independently of maternal health status. Methods and Results-Two hundred fifty-seven pregnancies of anti-SSA/Ro-positive mothers (40 exposed and 217 unexposed to HCQ) subsequent to the birth of a child with cardiac-NL were identified from 3 databases (United States, England, and France). Exposure was defined as the sustained use of HCQ throughout pregnancy with initiation before 10 weeks of gestation. The recurrence rate of cardiac-NL in fetuses exposed to HCQ was 7.5% (3 of 40) compared with 21.2% (46 of 217) in the unexposed group (P=0.050). Although there were no deaths in the exposed group, the overall case fatality rate of the cardiac-NL fetuses in the unexposed group was 21.7%. In a multivariable analysis that adjusted for database source, maternal race/ethnicity, and anti-SSB/La status, HCQ use remained significantly associated with a decreased risk of cardiac-NL (odds ratio, 0.23; 95% confidence interval, 0.06 -0.92; P=0.037). Similar results were obtained with propensity score analysis, an alternative approach to adjust for possible confounding by indication. Conclusion-Aggregate data from a multinational effort show that in mothers at high risk of having a child with cardiac-NL, the use of HCQ may protect against recurrence of disease in a subsequent pregnancy.

Original languageEnglish (US)
Pages (from-to)76-82
Number of pages7
JournalCirculation
Volume126
Issue number1
DOIs
StatePublished - Jul 3 2012

Keywords

  • Anti-SSA/Ro antibody
  • Cardiomyopathies
  • Congenital heart block
  • Hydroxychloroquine
  • Neonatal lupus
  • Prevention and control

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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