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LSO-087 Sub-optimal use of anti-malarial therapy for SLE in the Asia Pacific region; observations from the Asia Pacific lupus cohort
  1. Rangi Kandane-Rathnayake1,
  2. Alberta Hoi1,
  3. Louthrenoo Worawit2,
  4. Yi-Hsing Chen3,
  5. Jiacai Cho4,
  6. Aisha Lateef4,
  7. Laniyati Hamijoyo5,
  8. Shue Fen Luo6,
  9. Yeong-Jian Jan Wu6,
  10. Sandra Navarra7,
  11. Leonid Zamora7,
  12. Zhanguo Li8,
  13. Sargunan Sockalingam9,
  14. Yasuhiro Katsumata10,
  15. Masayoshi Harigai10,
  16. Yanjie Hao11,12,
  17. Zhuoli Zhang11,
  18. BMDB Basnayake13,
  19. Madelynn Chan14,
  20. Jun Kikuchi15,
  21. Tsutomu Takeuchi15,
  22. Shereen Oon12,
  23. Sang-Cheol Bae16,
  24. Sean O’Neill17,18,
  25. Fiona Goldblatt19,20,
  26. Kristine (Pek Ling) Ng21,
  27. Annie Hui Nee Law22,
  28. Nicola Tugnet23,
  29. Sunil Kumar24,
  30. Naoaki Ohkubo25,
  31. Michael Tee26,
  32. Cherica Tee26,
  33. Yoshiya Tanaka25,
  34. Chak Sing Lau27,
  35. Vera Golder1,
  36. Mandana Nikpour12 and
  37. Eric Morand1
  1. 1Department of Medicine, School of Clinical Sciences at MH, Monash University, Australia, Australia
  2. 2Department of Internal Medicine, Chiang Mai University Hospital, Thailand
  3. 3Department of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan
  4. 4Department of Rheumatology, National University Hospital, Singapore
  5. 5Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Indonesia
  6. 6Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital Chang Gung University, Taiwan
  7. 7Joint and Bone Center, University of Santo Tomas Hospital, Philippines
  8. 8Department of Rheumatology and Immunology, People’s Hospital Peking University Health Science Center, China
  9. 9Department of Medicine, University of Malaya, Malaysia
  10. 10Department of Rheumatology, Tokyo Women’s Medical University, Japan
  11. 11Department of Rheumatology and Immunology, Peking University First Hospital, China
  12. 12Department of Rheumatology, St Vincent’s Hospital Melbourne, Australia
  13. 13Department of Nephrology, Teaching Hospital Kandy, SriLanka
  14. 14Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, New Zealand
  15. 15Department of Internal Medicine, Keio University, Japan
  16. 16Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Republic of Korea
  17. 17Department of Rheumatology, Liverpool Hospital, Australia
  18. 18Department of Medicine and Health, University of New South Whales, Australia
  19. 19Department of Rheumatology, Flinders Medical Centre, Australia
  20. 20Department of Rheumatology, Royal Adelaide Hospital, Australia
  21. 21Department of Medicine, North Shore Hospital, New Zealand
  22. 22Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
  23. 23Department of Rheumatology, Greenlane Clinical Centre, New Zealand
  24. 24Department of Rheumatology, Middlemore Hospital, New Zealand
  25. 25Department of Internal Medicine, University of Occupational and Environmental Health, Japan
  26. 26Department of Medicine, University of the Philippines Manila, Philippines
  27. 27Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong


Background The Asia-Pacific League of Associations for Rheumatology (APLAR) recently published consensus recommendations, including overarching principles, general management, and specific treatment strategies for SLE in Asia. The use of hydroxychloroquine (HCQ) in all SLE patients was recommended unless contraindicated (statement 7).1 We evaluated the current therapeutic practice with respect to anti-malarial use in the Asia Pacific region against this recommendation.

Methods We used data from the Asia Pacific Lupus Collaboration (APLC) cohort, collected from SLE patients (meeting either ACR or SLICC criteria) between 2013 and 2020. Disease activity (SLEDAI-2K) and medication details were captured at enrolment and at routine visits. We defined medication categories based on glucocorticoid (GC), anti-malarial (AM) and immunosuppressant (IS) use at each visit and examined them in relation to clinical and serological disease activity.

Results We analysed 4,086 patients and 41,653 visits of data. Patients had no disease activity (i.e. SLEDAI-2K=0) in 25.5% of visits; clinical activity alone in 12.7% of visits; serological activity alone in 34.8% of visits, and both clinical and serological activity on 27% of visits. Regardless of disease activity, 78% of all patient visits were on GC, 67% on AM and 61% on IS. These proportions varied significantly among countries (figure 1). With regard to AM use, the majority was HCQ (62% of all visits) and a minority on chloroquine (4%).

Conclusions AM use was suboptimal and varied significantly across Asia Pacific countries There are disparities between current practice and Asia-Pacific SLE management guidelines, highlighting the need for knowledge dissemination.

Abstract LSO-087 Figure 1

Proportions of prednisolone (PNL), anti-malarials (AM) and immunosuppressants (IS) use, stratified by the APLC-participating countries. AU = Australia, CH=China, HK=Hong Kong, ID = Indonesia, JP = Japan, KR = Republic of Korea, MY = Malaysia, NZ = New Zealand, PH = Philippines, SG = Singapore, LK = Sri Lanka, TW = Taiwan, TH = Thailand


  1. Mok CC, Hamijoyo L, Kasitanon N, Chen DY, Chen S, Yamaoka K, et al. The Asia-Pacific League of Associations for Rheumatology consensus statements on the management of systemic lupus erythematosus. The Lancet Rheumatology. 2021;3(7):E517-E531.

  • Systemic lupus erythematosus
  • anti-malarials
  • treatment recommendations

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