Hydroxychloroquine Slows Progression of Cutaneous Lupus to SLE

TOPLINE:

Early initiation of hydroxychloroquine (HCQ) in patients with cutaneous lupus erythematosus (CLE) reduces the risk for progression to systemic lupus erythematosus (SLE) by 87% over time.

METHODOLOGY:

• Researchers conducted a longitudinal cohort study of 286 consecutive patients with isolated CLE at an autoimmune skin disease referral clinic in Israel between September 2020 and January 2024.
• Of all patients, 186 received HCQ 200 mg twice daily with or without topical corticosteroids/calcineurin inhibitors (TCS/TCI) and 100 received only topical treatment (TCS/TCI).
• Primary outcome was progression to SLE, as defined by the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria.
• Mean follow-up was 7 years.

TAKEAWAY:

• Overall, 36 patients (12.6%) progressed to SLE: 9 (4.8%) in the HCQ group and 27 (27%) in the topical therapy group (P < .001).
• The risk for progression to SLE was significantly lower in patients who received HCQ compared with those who received topical therapy alone (adjusted hazard ratio [HR], 0.061; P < .001). The early use of HCQ was associated with an 87% reduced risk for SLE over time (HR, 0.13; 95% CI, 0.06-0.27; P < .001). The protective effect was also observed in patients with chronic CLE and in both men and women.
• Severe SLE features were reported in 16 patients; the incidence ratio was 2.2% in the HCQ group compared with 12% in the topical therapy group (adjusted risk ratio, 0.16; P = .003).
• Autoantibody accrual showed significantly lower seroconversion rates in the HCQ group for antinuclear antibodies (P = .036), anti–Sjögren syndrome–related antigen A antibodies (P = .02), anti–Sjögren syndrome type B antibodies (P = .05), double-stranded DNA antibodies (P = .036), anti-Smith antibodies (P = .01), and anti-ribonucleoprotein antibodies (P = .04).

IN PRACTICE:

“Our findings suggest that early initiation of HCQ in patients with CLE may mitigate progression to SLE; however, more robust study designs, including randomized controlled trials, are needed to confirm this association,” the authors wrote.

SOURCE:

This study was led by Danielle Bar, MD, Department of Dermatology, faculty of medical and health sciences, Tel Aviv University, Tel Aviv, Israel. It was published online on February 25 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

Study limitations included the observational, nonrandomized design and absence of blinding. Additionally, the study did not include patients with CLE without systemic clinical manifestations.

DISCLOSURES:

This study did not receive any funding. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.