Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-associated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquine.

Abstract

BACKGROUND:

Based on the potential involvement of Toll-like receptor (TLR) signalling in the pathogenesis of neonatal lupus (NL), it was hypothesised that fetal exposure to hydroxychloroquine (HCQ), a TLR inhibitor, might reduce the risk of anti-SSA/Ro/SSB/La antibody-associated cardiac manifestations of NL (cardiac-NL).

METHODS:

Cardiac-NL children (N=50) and controls (N=151) were drawn from the following overlapping pregnancy studies: Research Registry for NL; PR Interval and Dexamethasone Evaluation in Cardiac-NL; and Predictors of Pregnancy Outcomes: Biomarkers in Antiphospholipid Syndrome and Systemic Lupus Erythematosus (SLE). Pregnancies met the following inclusion criteria: documentation of maternal anti-SSA/Ro/SSB/La antibodies at pregnancy, confirmation of medication use and child's outcome, a diagnosis of SLE before pregnancy and birth by 31 December 2007.

RESULTS:

Seven (14%) of the cardiac-NL children were exposed to HCQ compared with 56 (37%) of the controls (p=0.002; OR 0.28; 95% CI 0.12 to 0.63). Cases and controls were similar with respect to demographic and antibody status. Multivariable analysis adjusting for birth year, maternal race/ethnicity, antibody status, non-fluorinated steroid use and prior cardiac-NL risk yielded an OR associated with HCQ use of 0.46 (95% CI 0.18 to 1.18; p=0.10).

CONCLUSION:

This case-control study suggests that, in mothers with SLE with anti-SSA/Ro/SSB/La antibodies, exposure to HCQ during pregnancy may decrease the risk of fetal development of cardiac-NL. Prospective studies are needed for confirmation.

• Authors: Peter M Izmirly, Mimi Y Kim, Carolina Llanos, Phuong U Le, Marta M Guerra, Anca D Askanase, Jane E Salmon, Jill P Buyon
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 69 Issue 10 Pg. 1827-30 (Oct 2010) ISSN: 1468-2060 [Electronic] England
• PMID: 20447951 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antirheumatic Agents
• Autoantibodies
• Autoantigens
• Ribonucleoproteins
• SS-A antigen
• SS-B antigen
• Hydroxychloroquine

Topics

• Antirheumatic Agents (therapeutic use)
• Autoantibodies (blood)
• Autoantigens (immunology)
• Case-Control Studies
• Female
• Heart Diseases (etiology, immunology, prevention & control)
• Humans
• Hydroxychloroquine (therapeutic use)
• Infant, Newborn
• Lupus Erythematosus, Systemic (complications, drug therapy, immunology)
• Male
• Maternal-Fetal Exchange
• Pregnancy
• Pregnancy Complications (drug therapy, immunology)
• Prenatal Exposure Delayed Effects
• Ribonucleoproteins (immunology)