2024 American Academy of Neurology Abstract Website

Objective:

To examine the association between hydroxychloroquine use and the prevalence of microangiopathy in patients with SLE.

Background:

Patients with SLE have increased radiographic burden of microangiopathy, which can put them at increased risk of ischemic and hemorrhagic strokes, dementia and functional decline.

Design/Methods:

This is a retrospective analysis of a cohort of 158 SLE patients (77 patients not on HCQ matched on age, gender, duration and severity of disease with 81 patients on HCQ) who had brain MRI. The primary outcome was the odds of development of microangiopathy or small vessel disease (SVD), defined as radiographic evidence of white matter hyperintensities, enlarged perivascular spaces, lacunes or microhemorrhages, for HCQ users compared to nonusers.

Results:

The model, adjusted for cardiovascular risk factors, showed that HCQ users were less likely to develop SVD than nonusers (OR 0.19, 95% CI 0.083-0.442, p= 0.000). Users were at significantly older mean age at the time of uncovering SVD (m 52.41, SD= 8.062) compared to nonusers (m= 51.92, SD= 10.043) and experienced a significantly longer mean duration from the time of SLE diagnosis to uncovering SVD (m= 26.02, SD= 9.16) compared to nonusers (m= 24.21, SD= 0.83). Patients who only used HCQ for under 5 years were not significantly more likely to develop SVD when compared to users for over 5 years (OR 5.51, p=0.164).

Conclusions:

HCQ users experienced 81% reduction of the odds of developing SVD compared to nonusers. Patients who have SVD while on HCQ tend to be diagnosed at older age and have longer disease free period. These results suggest potential neurovascular protective benefits of HCQ and support the need for indefinite treatment in all SLE patients who don’t have contraindications. They additionally support the rule of HCQ as supplementary secondary prevention to antithrombotics and lipid lowering agents for SLE patients who go on to develop stroke.