A large, multi-ethnic, international, longitudinal starting cohort study by scholars from Brazil and the United States included 1480 patients with lupus, of whom 1141 (77%) were on antimalarials (mean exposure time of 48.5 months). Eighty-nine patients (6.0%) died during follow-up. Compared with non-users, mortality decreased with longer duration of antimalarial use (11.5% vs. 4.4%, P<0.001). Mortality rates (in cases/1000 persons/year) were 3.85 [70 cases (6.1%), 6-11 months of medication], 2.7 [146 cases (12.8%), 1-2 years of medication] and 0.54 [925 cases (81.1%), more than 2 years of medication] for drug users and 3.07 for non-users, respectively. After correcting for potential confounders, the Cox regression model showed that the use of antimalarials was associated with a 38% reduction in mortality (risk ratio of 0.62).