Danielle Bar, Sharon Baum, Zvi Segal, Aviv Barzilai, Amit Druyan, Merav Lidar
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Early Initiation of Hydroxychloroquine in Cutaneous Lupus Erythematosus to Prevent Progression to Systemic Lupus Erythematosus: A Long-term Follow-up Study.
Background: The progression from cutaneous lupus erythematosus (CLE) to systemic lupus erythematosus (SLE) remains a significant clinical challenge, with identified risk factors but no established preventative strategies.
Objectives: To evaluate whether early hydroxychloroquine (HCQ) initiation reduces the risk of CLE progressing to SLE.
Methods: A longitudinal study of 286 consecutive patients with isolated CLE (full study cohort), treated with HCQ (n = 186) or topical corticosteroids/calcineurin inhibitors (TCS/CNI; n =100). Progression to SLE was defined using the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria.
Results: Progression to SLE occurred in 4.8% of the HCQ group and 27% of the TCS/TCI group (p<0.001). Early initiation of HCQ was associated with an 87% reduction in SLE risk over time (HR: 0.13, 95% CI: 0.06-0.27, p<0.001), consistent across all CLE severity levels and both positive and negative baseline antinuclear antibody titers. Severe SLE with end-organ involvement was also significantly less frequent in the HCQ group (risk ratio: 0.16, 95% CI: 0.19-0.86, p=0.003).
Limitations: Observational design.
Conclusions: Early HCQ treatment demonstrated protective effects against progression to SLE, supporting its use as a preferred strategy in managing CLE to prevent systemic involvement.
期刊介绍：
The Journal of the American Academy of Dermatology (JAAD) is the official scientific publication of the American Academy of Dermatology (AAD). Its primary goal is to cater to the educational requirements of the dermatology community. Being the top journal in the field, JAAD publishes original articles that have undergone peer review. These articles primarily focus on clinical, investigative, and population-based studies related to dermatology. Another key area of emphasis is research on healthcare delivery and quality of care. JAAD also highlights high-quality, cost-effective, and innovative treatments within the field. In addition to this, the journal covers new diagnostic techniques and various other topics relevant to the prevention, diagnosis, and treatment of skin, hair, and nail disorders.
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