Increased incidence of SLE flares during pregnancy is modified by hydroxychloroquine
medwireNews: An increased incidence of disease flares during pregnancy and 3 months after delivery in women with systemic lupus erythematosus (SLE) can be significantly reduced with continued use of hydroxychloroquine (HCQ), according to a large cohort study.
Pregnant women with SLE had a 59% increased risk for flare during pregnancy and a 48% increased risk in the 3 months postpartum, compared with non-pregnant women with SLE.
However, the increased risk for flares during pregnancy, defined as at lease a one point increase in Physician Global Assessment (PGA) of disease activity score, was only significant for women not taking HCQ, at 83%. For pregnant women taking HCQ, the increase in risk was a nonsignificant 26%. Similar results were seen for the 3-month postpartum period.
The data were obtained from the largest cohort study of pregnancy in women with SLE to date, comprising 1349 women from the Hopkins Lupus Cohort, and included 398 pregnancies in 304 women, from 1987 to 2015.
HCQ was taken during 58% of pregnancies and 80% of women took HCQ at some point during the median follow-up of 3.9 years.
The researchers, led by Amanda Eudy (Duke University Medical Center, Durham, North Carolina, USA), note that exposure to HCQ was greater after 2000 compared with earlier years, both during and outside of pregnancy.
“While in prior decades many women with lupus were expected to flare during or after pregnancy, more recent data suggest that a large proportion of women have minimal disease activity throughout the period,” they write in the Annals of the Rheumatic Diseases.
“We hypothesize that routine continuation of HCQ in modern lupus pregnancies may be the driving force for the diminution in lupus activity during and following pregnancy.”
Prednisone may also play a role in decreasing the risk for flares during pregnancy, the researchers suggest, as it was found to be an effect modifier in a sensitivity cohort of women with an observed pregnancy when flares were defined using Safety of Estrogens in Lupus National Assessment–Systemic Lupus Erythematosus Disease Activity Index (SELENA–SLEDAI), although not when defined using the PGA.
Previous research has indicated that high disease activity during pregnancy is associated with preterm births and pregnancy loss, so these findings are clinically significant for pregnant women, says the team.
“The results suggest we can be more optimistic with many women with lupus: they do not need to expect a lupus flare during or after pregnancy, particularly if they continue HCQ,” they conclude.
By Catherine Booth
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