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Objective: To assess the daily and weight-adjusted dosages of hydroxychloroquine (HCQ) and the effects on long-term remission in the Lupus-Cruces cohort., Methods: Observational study of routine clinical care data. We selected inception patients treated with HCQ with at least 5 years of follow-up. Prolonged remission was achieved when patients fulfilled definitions of remission in systemic lupus erythematosus remission criteria in five consecutive yearly visits. The associations between the weight-adjusted dose of HCQ during 5 years and prolonged remission were analysed. We also investigated the associations between prednisone doses, immunosuppressives (IS) and other antimalarial use with HCQ doses., Results: 150 inception patients fulfilled the inclusion criteria. The mean starting dose of HCQ was 206 mg/day. The mean weight-adjusted starting dose of HCQ was 3.1 mg/kg/day with no patients treated with doses ≥5 mg/kg/day. Treatment with HCQ was maintained during the whole 5-year follow-up time in 147 patients (98%). The mean dose of HCQ during the 5-year follow-up was 194.6 mg/day (2.9 mg/kg/day). 108 patients (72%) were in prolonged remission. The mean weight-adjusted dose of HCQ per patient did not differ between those who did and did not achieve prolonged remission (2.9 vs 3 mg/kg/day, p=0.5). The dose of prednisone per patient (mean 2.3 mg/day during the 5-year follow-up) did not differ according to the weight-adjusted dose of HCQ. The mean weight-adjusted HCQ dose during the whole follow-up was the same in patients treated or not with IS or with mepacrine., Conclusions: With the use of HCQ at stable doses of 200 mg/day (or 3.0-3.5 mg/kg/day) as the background therapy in patients with systemic lupus erythematosus, the majority of patients achieved prolonged remission., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: After more than 20 years of sustained work, the Latin American Group for the Study of Lupus (GLADEL) has made a significant number of contributions to the field of lupus, not only in the differential role that race/ethnicity plays in its course and outcome but also in several other studies including the beneficial effects of using antimalarials in lupus patients and the development of consensus guidelines for the treatment of lupus in our region. Methods: A new generation of "Lupus Investigators" in more than 40 centers throughout Latin America has been constituted in order to continue the legacy of the investigators of the original cohort and to launch a novel study of serum and urinary biomarkers in patients with systemic lupus erythematosus. Results: So far, we have recruited 807 patients and 631 controls from 42 Latin-American centers including 339 patients with SLE without renal involvement, 202 patients with SLE with prevalent but inactive renal disease, 176 patients with prevalent and active renal disease and 90 patients with incident lupus nephritis. Conclusions: The different methodological aspects of the GLADEL 2.0 cohort are discussed in this manuscript, including the challenges and difficulties of conducting such an ambitious project., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: Serological biomarkers will be carried out centrally by INOVA/Werfen laboratories. Janssen Pharmaceutical Companies of Johnson & Johnson is planned to provide logistic and financial support for transcriptome studies. Neither Inova laboratories nor Janssen Pharmaceutical Companies have participated or influenced the development of the project, nor do they have access to the information collected in the database.

Introduction: Assessment of risk both for pregnancy morbidity and thrombosis in the presence of anti-phospholipid antibodies (aPL) is still a challenge in Systemic Lupus Erythematosus (SLE) patients. The Global Antiphospholipid Syndrome Score (GAPSS) takes into account the aPL profile (criteria and non-criteria aPL), the conventional cardiovascular risk factors and the autoimmune antibody profile. An adjusted model of the score (aGAPSS) excluding anti-phosphatidylserine/Prothrombin (aPS/PT), suggests that the score is able to stratify patients for their rate of events making it widely applicable in daily clinical practice., Objective: To validate the aGAPSS in a multicentric cohort of SLE patients in Argentina., Patients and Methods: consecutive SLE patients with and with andwithout thrombotic events from seven Rheumatologist centers were included. Traditional cardiovascular risk factors, aPL antibodies and medications received (aspirin, hydroxychloroquine and anticoagulation) were collected. The score aGAPSS was calculated for each patient at the last visit by adding together the points corresponding to the risk factors: 1 for hypertension, 3 for dyslipidemia, 4 for LA and B2GPI (IgM or IgG) antibodies and 5 for aCL (IgM or IgG) antibodies. The discriminative ability of the aGAPSS was calculated by measuring the area under the receiver operating characteristic curve (AUC). Multivariate logistic regression analysis was performed to examine the impact of multiple cardiovascular risk factors and laboratory parameters on the occurrence of thrombosis., Results: Two hundred and ninety-six SLE patients were included. One-hundred and twenty-one patients (40.9%) presented thrombotic and/or pregnancy complications. Median aGAPSS was significantly higher in patients who experienced an event (thrombosis and/or pregnancy morbidity) compared with those without [4 (IQR 1-9) versus 1 (IQR 0-5); p < 0.001]. The best cut off point for the diagnosis of thrombosis and/or pregnancy complications was aGAPSS ≥4. Multivariate logistic regression analysis showed that aCL antibodies [OR 2.1 (95% CI 1.16-3.90); p = 0.015] were an independent risk factors for thrombotic events., Conclusions: This score is a simple tool, easy to apply to SLE patients in daily practice. The use of the aGAPSS could change the non-pharmacologic and pharmacologic treatment in higher risk patients to improve their survival.