{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T15:10:55Z","timestamp":1778425855279,"version":"3.51.4"},"reference-count":41,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hydroxychloroquine is recommended for all patients with systemic lupus erythematosus (SLE) because of its efficacy and safety. Previous studies of antimalarial toxicity under non-experimental conditions have often grouped hydroxychloroquine and chloroquine. This study focuses on the long-term toxicity of antimalarial drugs in SLE patients at a single reference centre. The research seeks to identify trends in antimalarial toxicity and determine risk factors contributing to long-term adverse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Retrospective data were collected from electronic medical records of consecutively diagnosed SLE patients, followed for at least 5\u00a0years, from 1998 to 2017. The outcome variable \u201cantimalarial long-term adverse effect\u201d was considered if the adverse effect occurred after at least 5 years of continuous antimalarial treatment. Hazard regression analysis was used to identify independent factors associated with long-term antimalarial adverse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three hundred 22 patients followed for a median of 15 years were analysed. The mean age at SLE diagnosis was 33.4 years, and 91.3% were women. Antimalarial drugs were started in 314 (97.5%) patients. Adverse effects were observed in 55 (17.5%) patients, mainly macular toxicity (11.5%). The incidence of all types of toxicity was higher in the long-term users than in the short-term users (12.1% vs 5.4%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; .001). Previous use of chloroquine (HR 3; 95%CI 1-9), anti-\u00df2-glycoprotein antibody positivity (HR 2; 95%CI 1-4) and hydroxychloroquine doses higher than 5\u00a0mg\/kg\/day (HR 2.6; 95%CI 1-7) were identified as independent factors associated with long-term antimalarial toxicity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In our experience over the past 20 years, almost all SLE patients were treated with antimalarials. Macular toxicity was the most common long-term adverse effect. Patients with previous use of chloroquine, higher than recommended doses of hydroxychloroquine, and positive anti-\u00df2-glycoprotein antibodies were more likely to develop long-term antimalarial toxicity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09612033251317557","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T13:35:26Z","timestamp":1738157726000},"page":"243-252","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["New insights into the long-term adverse effects of antimalarials in patients with systemic lupus erythematosus"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1763-1880","authenticated-orcid":false,"given":"Olga","family":"Ara\u00fajo","sequence":"first","affiliation":[{"name":"Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Hospital Cl\u00ednic de Barcelona, Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1336-0163","authenticated-orcid":false,"given":"Gerard","family":"Espinosa","sequence":"additional","affiliation":[{"name":"Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Hospital Cl\u00ednic de Barcelona, Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9","family":"Hern\u00e1ndez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Hospital Cl\u00ednic de Barcelona, Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9992-9148","authenticated-orcid":false,"given":"Halbert","family":"Hern\u00e1ndez-Negr\u00edn","sequence":"additional","affiliation":[{"name":"Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Hospital Cl\u00ednic de Barcelona, Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfredo","family":"Ad\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hospital Cl\u00ednic de Barcelona. Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Pelegr\u00edn","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hospital Cl\u00ednic de Barcelona. Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6085-492X","authenticated-orcid":false,"given":"Ricard","family":"Cervera","sequence":"additional","affiliation":[{"name":"Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases of the Catalan and Spanish Health Systems, Member of the European Reference Centres (ERN) Re-CONNET and RITA, Hospital Cl\u00ednic de Barcelona, Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,1,27]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2023-224762"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.57.10.582"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-205139"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400928"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-214819"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/09612033221100908"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(02)01168-5"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.11.017"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2016.01.058"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2013.1404"},{"issue":"12","key":"e_1_3_4_12_2","first-page":"1535","article-title":"Humphrey visual field findings in hydroxychloroquine toxicity","volume":"25","author":"Anderson C","year":"2011","unstructured":"Anderson C, Blaha GR, Marx JL. Humphrey visual field findings in hydroxychloroquine toxicity. Eye Lond Engl 2011; 25(12): 1535\u20131545.","journal-title":"Eye Lond Engl"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/archophthalmol.2011.371"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.2147\/OPTH.S14257"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0b013e3182247535"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2014.3459"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcreu.2021.05.010"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32064-5"},{"issue":"4","key":"e_1_3_4_19_2","first-page":"692","article-title":"Comparison of hydroxychloroquine and chloroquine use and the development of retinal toxicity","volume":"12","author":"Finbloom DS","year":"1985","unstructured":"Finbloom DS, Silver K, Newsome DA, et al. Comparison of hydroxychloroquine and chloroquine use and the development of retinal toxicity. J Rheumatol 1985; 12(4): 692\u2013694.","journal-title":"J Rheumatol"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00393-020-00785-4"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-021-04868-6"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.2208"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.md.0000091181.93122.55"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.27300"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rce.2016.09.006"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/09612033221115618"},{"issue":"3","key":"e_1_3_4_27_2","first-page":"380","article-title":"Long-term use of antimalarial drugs in rheumatic diseases","volume":"30","author":"Jover JA","year":"2012","unstructured":"Jover JA, Leon L, Pato E, et al. Long-term use of antimalarial drugs in rheumatic diseases. Clin Exp Rheumatol 2012; 30(3): 380\u2013387.","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmaid.2020.101812"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.101766"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000743"},{"key":"e_1_3_4_31_2","article-title":"How toxic is an old friend? A review of the safety of hydroxychloroquine in clinical practice","author":"Fairley JL","year":"2022","unstructured":"Fairley JL, Nikpour M, Mack HG, et al. How toxic is an old friend? A review of the safety of hydroxychloroquine in clinical practice. Intern Med J. 2022. Available at: https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/imj.15908","journal-title":"Intern Med J"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2020.1817479"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/1759720X211073001"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-86079-4"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2020.04.024"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203317734922"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-018-0111-8"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.5935\/0004-2749.20190002"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-024-06461-6"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-020-01380-2"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keac626"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2022-000789"}],"container-title":["Lupus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09612033251317557","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09612033251317557","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09612033251317557","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:28:38Z","timestamp":1777678118000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09612033251317557"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,27]]},"references-count":41,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1177\/09612033251317557"],"URL":"https:\/\/doi.org\/10.1177\/09612033251317557","relation":{},"ISSN":["0961-2033","1477-0962"],"issn-type":[{"value":"0961-2033","type":"print"},{"value":"1477-0962","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,27]]}}}