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Systemic lupus erythematosus

Hydroxychloroquine dose: balancing toxicity and SLE flare risk

Contemporary guidelines for the management of systemic lupus erythematosus (SLE) recommend prescribing hydroxychloroquine dosages of 5 mg/kg per day or lower to minimize toxicity. However, new evidence raises serious concerns about the risk of SLE flare associated with such doses. How do the benefits and risks of this controversial recommendation balance out?

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References

  1. Fanouriakis, A. et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann. Rheum. Dis. 78, 736–745 (2019).

    Article  CAS  Google Scholar 

  2. Costedoat-Chalumeau, N., Isenberg, D. & Petri, M. Comment on the 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus by Fanouriakis et al. Ann. Rheum. Dis. 79, e90 (2020).

    Article  Google Scholar 

  3. Jorge, A. M. et al. Hydroxychloroquine dose per ophthalmology guidelines and the risk of systemic lupus erythematosus flares. JAMA 328, 1458–1460 (2022).

    Article  CAS  Google Scholar 

  4. Almeida-Brasil, C. C. et al. Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Ann. Rheum. Dis. 81, 370–378 (2022).

    Article  CAS  Google Scholar 

  5. Melles, R. B. & Marmor, M. F. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol. 132, 1453–1460 (2014).

    Article  Google Scholar 

  6. Petri, M., Konig, M. F., Li, J. & Goldman, D. W. Association of higher hydroxychloroquine blood levels with reduced thrombosis risk in systemic lupus erythematosus. Arthritis Rheumatol. 73, 997–1004 (2021).

    Article  CAS  Google Scholar 

  7. Feldman, C. H. et al. Dynamic patterns and predictors of hydroxychloroquine nonadherence among Medicaid beneficiaries with systemic lupus erythematosus. Semin. Arthritis Rheum. 48, 205–213 (2018).

    Article  Google Scholar 

  8. Marmor, M. F. et al. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 Revision). Ophthalmology 123, 1386–1394 (2016).

    Article  Google Scholar 

  9. Lenfant, T. et al. Risk factors for hydroxychloroquine retinopathy in systemic lupus erythematosus: a case-control study with hydroxychloroquine blood-level analysis. Rheumatology (Oxford) 59, 3807–3816 (2020).

    Article  CAS  Google Scholar 

  10. Costedoat-Chalumeau, N. et al. A prospective international study on adherence to treatment in 305 patients with flaring SLE: assessment by drug levels and self-administered questionnaires. Clin. Pharmacol. Ther. 103, 1074–1082 (2018).

    Article  CAS  Google Scholar 

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Correspondence to Nathalie Costedoat-Chalumeau.

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Lenfant, T., Costedoat-Chalumeau, N. Hydroxychloroquine dose: balancing toxicity and SLE flare risk. Nat Rev Rheumatol 19, 6–7 (2023). https://doi.org/10.1038/s41584-022-00868-3

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  • DOI: https://doi.org/10.1038/s41584-022-00868-3

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