Subtherapeutic hydroxychloroquine concentration is associated with increased disease activity and greater organ damage in lupus

Objective To investigate the effects of the serum HCQ concentration on clinical manifestations, disease activity and organ damage in a longitudinal cohort of SLE patients. Methods The 338 SLE patients were assessed with respect to their demographic data, clinical and laboratory findings, Physician's Global Assessment (PGA), adjusted mean SLEDAI-2000 (AMS) and SLICC Damage Index (SDI) annually for 5 consecutive years. Patients were divided into two groups according to their serum HCQ concentration at baseline: subtherapeutic (<500 ng/ml) and therapeutic (& GE;500 ng/ml) groups. The impact of the HCQ concentration on the clinical outcomes was evaluated in a longitudinal analysis using a generalized estimating equation (GEE). Results Of the 338 patients, 287 (84.9%) were in the subtherapeutic group at baseline. This group had a higher incidence of newly developed LN (P = 0.036) and had been prescribed higher mean and cumulative doses of prednisolone (P = 0.003 and P = 0.013, respectively) than the therapeutic group. In multivariable analyses based on GEE, the subtherapeutic group had a higher AMS score (& beta; = 1.398, 95% CI 0.607, 2.189; P < 0.001), higher PGA score (& beta; = 0.328, 95% CI 0.215, 0.441; P < 0.001) and higher SDI score (& beta; = 0.366, 95% CI 0.061, 0.671; P = 0.019) across all 5 years. Conclusion The subtherapeutic HCQ concentration was associated with the development of new-onset LN, and had significant associations with disease activity and cumulative organ damage in SLE patients over time.

Automated summary

This study investigated the effects of serum HCQ concentration on clinical manifestations, disease activity, and organ damage in SLE patients. The results showed that patients with subtherapeutic HCQ concentration had a higher incidence of newly developed LN and higher disease activity and organ damage scores over 5 years. Therefore, maintaining an appropriate HCQ concentration can improve the clinical outcomes of SLE patients.