{
  "abstract": "Introduction Hydroxychloroquine (HCQ) is an antimalarial drug that interferes with dendritic cells and monocytes, acidifies endosomes, and modulates toll-like receptors, reducing autoimmune responses and cell proliferation through autophagy inhibition. HCQ is widely used in rheumatic diseases for its immunomodulatory properties and is often prescribed in systemic sclerosis (SSc), despite the lack of confirmation of its efficacy in randomized trials. The aim of our study was to compare disease progression trajectories between HCQ-treated and -untreated SSc patients.Material and Methods This retrospective, multicenter observational study included patients diagnosed with SSc according to the ACR/EULAR 2013 criteria, recruited from two Italian Rheumatology centers. Patients were grouped based on HCQ treatment. Demographic, clinical, serological, and capillaroscopic data, as well as concomitant therapies, were recorded at baseline. At 6, 12-, 24-, 36-, and 60-months follow-up visits disease progression was determined according to validated criteria encompassing cutaneous, pulmonary, cardiac, and musculoskeletal domains, or the need to escalate immunosuppressive therapy. Progression-free survival was defined as the absence of worsening or new organ involvement. To test the study hypothesis Kaplan-Meier survival curves and Cox proportional hazards models were applied, stratifying the population by antibody profile (ACA+ or Scl70+).Results A total of 301 patients with SSc were included (167 in the HCQ group and 134 in the non-HCQ group). Baseline characteristics were broadly similar between groups ( table 1), with no significant differences in age or disease duration. The HCQ group had a higher prevalence of ACA+ (50.8% vs 36.5%, p=0.036), a lower prevalence of Scl70+ (25.7% vs 44.7%, p<0.001) and interstitial lung disease (ILD, 13.1% vs 31.3%, p<0.001). Mean mRSS was lower in the HCQ group (3±5 vs 5±7, p=0.004), while MMF use was more frequent in non-HCQ group (13.1% vs 6.0%, p=0.002). Kaplan-Meier curves demonstrated significant differences in progression-free survival between HCQ-treated patients in both ACA+ and Scl70+ (p<0.001) subgroups.In multivariable Cox regression models, HCQ treatment was independently associated with a reduced hazard of progression in both ACA+ (n=134, events=16; HR=0.05, 95% CI 0.01–0.25) and Scl70+ (n=103, events=39; HR=0.14, 95% CI 0.06–0.34) subgroups.Conclusions In this retrospective study, HCQ use was associated with a lower risk of disease progression in patients with SSc, in both ACA+ and Scl70+ subgroups, over a 60 -months follow-up period. While the findings might suggest a potential protective role of HCQ, they must be interpreted with caution since baseline imbalances and confounding by indication may partially explain these associations.Abstract P.286 Figure 1a) Kaplan-Meier curve showing the probability of remaining free from immunosuppressive therapy intensification in anti-Sci70 positive SSc patients, stratified by HCQ treatment; b) Forest plot illustrating the hazard ratios for progression in anti-Sc170 positive SSc patients; c) Kaplan-Meier curve showing the probability of remaining free from immunosuppressive therapy intensification in ACA-positive SSc patients, stratified by HCQ treatment; d) Forest plot illustrating the hazard ratios for progression in ACA-positive Sse patientsAbstract P.286 Table 1Comparison of demographical data and symptoms in SSe patients with or without treatment with hydroxychloroquine (HCQ)",
  "authors": [
    {
      "affiliations": [
        "Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence,Careggi Hospital, Florence, Italy"
      ],
      "name": "Francesco Bonomi"
    },
    {
      "affiliations": [
        "Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Rheumatology Unit, Sapienza University, Rome, Italy"
      ],
      "name": "Ilaria Bisconti"
    },
    {
      "affiliations": [
        "Scleroderma Unit, AOU Careggi, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy"
      ],
      "name": "Ilenia Mallia"
    },
    {
      "affiliations": [
        "Rheumatology Unit, IRCCS Ospedale Galeazzi Sant’Ambrogio, Milan, Italy",
        "Department of Biomedical and Clinical Sciences, Milan, Italy"
      ],
      "name": "Greta Pellegrino"
    },
    {
      "affiliations": [
        "Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence,Careggi Hospital, Florence, Italy"
      ],
      "name": "Gabriele Ciuti"
    },
    {
      "affiliations": [
        "Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Rheumatology Unit, Sapienza University, Rome, Italy"
      ],
      "name": "Gloria Muolo"
    },
    {
      "affiliations": [
        "Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Rheumatology Unit, Sapienza University, Rome, Italy"
      ],
      "name": "Martina Salerno"
    },
    {
      "affiliations": [
        "Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Rheumatology Unit, Sapienza University, Rome, Italy"
      ],
      "name": "Simona Truglia"
    },
    {
      "affiliations": [
        "Scleroderma Unit, AOU Careggi, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy"
      ],
      "name": "Cristiano Barbetta"
    },
    {
      "affiliations": [
        "Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence,Careggi Hospital, Florence, Italy"
      ],
      "name": "Silvia Peretti"
    },
    {
      "affiliations": [
        "Scleroderma Unit, AOU Careggi, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy"
      ],
      "name": "Serena Guiducci"
    },
    {
      "affiliations": [
        "Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Rheumatology Unit, Sapienza University, Rome, Italy"
      ],
      "name": "Valeria Riccieri"
    },
    {
      "affiliations": [
        "Scleroderma Unit, AOU Careggi, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy"
      ],
      "name": "Silvia Bellando Randone"
    }
  ],
  "title": "P.286 Hydroxychloroquine and disease progression in systemic sclerosis: insights from antibody-stratified survival analyses",
  "uid": "337d11b5-27e1-593b-bc78-3079efa8587f"
}