TOPLINE:

In a study involving two observational cohorts, hydroxychloroquine (HCQ) treatment was associated with a lower 5-year risk for cardiometabolic and atherosclerotic events, including hyperlipidemia, coronary artery disease (CAD), and stroke among patients with isolated discoid lupus erythematosus (DLE).

METHODOLOGY:

• Researchers conducted a single-center, retrospective cohort study of 106 adults with isolated DLE between 2013 and 2020. Their mean age was 47.8 years; 67.9% were female; 67% were Black, 6.6% were Asian, and 26.4% were White.
• They validated the findings in a multi-institutional TriNetX analysis with 2260 propensity score-matched pairs. Their mean age was 52 years; 77% were female; 58.6%-60.5% were White, and 27% were Black.
• Patients were categorized as HCQ users (initiated HCQ within 5 years of diagnosis) or HCQ-naive (no HCQ prescriptions during the same period).
• Primary outcomes included the 5-year incidence of hypertension, hyperlipidemia, type 2 diabetes (T2D), CAD, peripheral arterial disease (PAD), angina, myocardial infarction, stroke, and major adverse cardiovascular events.

TAKEAWAY:

• In the single-center cohort, HCQ users had a lower 5-year incidence of hyperlipidemia (23.3% vs 47.8%; adjusted odds ratio [aOR], 0.25; P = .005), PAD (1.7% vs 17.4%; aOR, 0.15; P = .012), angina (3.3% vs 26.1%; aOR, 0.13; P = .002), and CAD (10.0% vs 26.1%; aOR, 0.31; P = .039).
• In the TriNetX matched cohort, HCQ was associated with a lower 5-year risk for hypertension than in HCQ-naive patients (risk ratio [RR], 0.81; P = .016), hyperlipidemia (RR, 0.56; P < .001), T2D (RR, 0.69; P = .005), CAD (RR, 0.71; P = .011), and stroke (RR, 0.45; P = .001).
• Absolute risk reductions (ARRs) were clinically meaningful for several outcomes over 5 years, including hypertension (ARR, 3.2%; number needed to treat [NNT], 32), hyperlipidemia (ARR, 6.7%; NNT, 15), T2D (ARR, 2.0%; NNT, 50), and CAD (ARR, 1.7%; NNT, 59).

IN PRACTICE:

“HCQ use in isolated DLE was associated with lower 5-year risk of several major cardiometabolic and atherosclerotic outcomes, including hyperlipidemia, hypertension, T2DM, CAD, PAD, and stroke,” the study authors concluded. The findings “support considering HCQ not only for control of cutaneous disease but also as part of a broader strategy to mitigate cardiovascular risk,” they added, noting that early initiation “may be particularly beneficial in patients with traditional CVD [cardiovascular disease] risk factors, regardless of DLE extent.”

SOURCE:

The study was led by Anjana Srikumar, BA, Johns Hopkins University School of Medicine, Baltimore, and was published online on April 16 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The study limitations included a retrospective design, a small single-center cohort, and reliance on diagnostic coding. Additionally, medication adherence, dosing, and validated measures of cutaneous disease activity were not captured.

DISCLOSURES:

One author was supported by the Dermatology Foundation Medical Dermatology Career Development Award and disclosed serving as a site principal investigator for the LAVENDER trial evaluating anifrolumab, a therapy targeting type I interferon signaling.

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