Background: Although hydroxychloroquine (HCQ) is a mainstay of treatment for patients with systemic lupus erythematosus (SLE), ocular toxicity can result from accumulated exposure. As the longevity of patients with SLE improves, data are needed to balance the risk of ocular toxicity and the risk of disease flare, especially in older patients with quiescent disease. Accordingly, this study was initiated to examine the safety of HCQ withdrawal in older SLE patients.
Methods: Data were obtained by retrospective chart review at three major lupus centers in New York City. Twenty-six patients who discontinued HCQ and thirty-two patients on HCQ matched for gender, race/ethnicity, and age were included in this study. The primary outcome was the occurrence of a lupus flare classified by the revised version of the Safety of Estrogens in Lupus Erythematosus: National Assessment version of the Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) Flare composite index, within 1 year of HCQ withdrawal or matched time of continuation.
Results: Five patients (19.2%) in the HCQ withdrawal group compared to five (15.6%) in the HCQ continuation group experienced a flare of any severity (odds ratio [OR] = 1.28; 95% CI 0.31, 5.30; p = 0.73). There were no severe flares in either group. The results were similar after adjusting for length of SLE, number of American College of Rheumatology criteria, low complement levels, and SELENA-SLEDAI score, and in a propensity score analysis (OR = 1.18; 95% CI 0.23, 6.16; p = 0.84). The analysis of time to any flare revealed a non-significant earlier time to flare in the HCQ withdrawal group (log-rank p = 0.67). Most flares were in the cutaneous and musculoskeletal systems, but one patient in the continuation group developed pericarditis. The most common reason for HCQ withdrawal was retinal toxicity (42.3%), followed by patient's preference (34.6%), other confirmed or suspected adverse effects (15.4%), ophthalmologist recommendation for macular degeneration (3.8%), and rheumatologist recommendation for quiescent SLE (3.8%).
Conclusions: In this retrospective study of older stable patients with SLE on long-term HCQ, withdrawal did not significantly increase the risk of flares.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430013 | PMC |
| http://dx.doi.org/10.1186/s13075-020-02282-0 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Evaluation and prediction of relapse risk in stable systemic lupus erythematosus patients after glucocorticoid withdrawal (PRESS): an open-label, multicentre, non-inferiority, randomised controlled study in China.
Ann Rheum Dis
November 2024
Department of Rheumatology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Clinical Immunology Centre, Chinese Academy of Medical Sciences, Beijing, China
Article Synopsis
- The study aimed to analyze the relapse rates in systemic lupus erythematosus (SLE) patients after stopping glucocorticoids (GC) with or without hydroxychloroquine (HCQ) maintenance therapy.
- Conducted over 33 weeks, the trial divided 333 patients into three groups: one that stopped both drugs, one that only stopped GC while continuing HCQ, and one that continued both treatments.
- Results showed higher relapse rates in the drug-free group (26.1%) compared to both HCQ (11.2%) and dual maintenance (4.7%) groups, indicating that continuing HCQ could help prevent relapses after stopping GC.
Multidisciplinary consensus on the use of hydroxychloroquine in patients with systemic lupus erythematosus.
Reumatol Clin (Engl Ed)
July 2024
Rheumatology Department, Araba University Hospital, Vitoria, Spain; Research Institute BIOARABA, Spain; País Vasco University, Spain. Electronic address:
Article Synopsis
- Hydroxychloroquine (HCQ) is the main treatment for systemic lupus erythematosus (SLE), but its use varies widely among clinicians. A consensus was created to standardize recommendations for healthcare providers.
- A systematic literature review led to the identification of relevant studies, resulting in a total of 11 recommendations for the appropriate use of HCQ, covering initiation, maintenance, and monitoring. All committee members unanimously agreed on these guidelines.
- The evidence supports HCQ's safety and effectiveness, emphasizing the importance of tailored dosing and careful monitoring to balance treatment benefits against risks, particularly concerning retinal toxicity and SLE flare-ups.
Risk of flare in patients with SLE in remission after hydroxychloroquine or chloroquine withdrawal.
Joint Bone Spine
December 2024
Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France; Sorbonne Université, centre de référence des maladies auto-immunes et auto-inflammatoires systémiques rares de l'adulte d'Ile-de-France, Centre et Martinique, Service de Médecine Interne 2, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Institut E3M, Paris, France. Electronic address:
Objective: Previous studies have provided evidence that the discontinuation of hydroxychloroquine (HCQ), and chloroquine (CQ), in patients with systemic lupus erythematosus (SLE) is associated with an increased risk of disease flares, with limited information on the level of disease activity at the time of HCQ/CQ discontinuation. Here we aimed to describe the risk of SLE flare after withdrawal of HCQ or CQ in patients with SLE in remission.
Methods: Case-control study (1:2) comparing the evolution of patients with SLE after HCQ/CQ withdrawal for antimalarial retinopathy (cases) with patients with SLE matched for sex, antimalarial treatment duration and age at SLE diagnosis, whose antimalarial treatment was continued throughout the entire follow-up period (controls).
Efficacy of antimalarials in oral lichen planus: A systematic review.
Oral Dis
October 2024
Department of Dental Clinical Specialties, ORALMED Research Group, School of Dentistry, Complutense University, Madrid, Spain.
Objective: To evaluate whether hydroxychloroquine (HCQ) or chloroquine (CQ) are effective for the treatment of oral lichen planus (OLP).
Materials And Methods: A literature search was conducted in four databases. Clinical studies investigating the effect of HCQ/CQ in patients with OLP were included.
Effect of traditional therapeutics on prevalence and clinical outcomes of coronavirus disease 2019 in Chinese patients with autoimmune diseases.
J Transl Autoimmun
June 2024
Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
The impact of the Coronavirus disease 2019 (COVID-19) pandemic on autoimmune diseases (AID) patients has been an important focus. This study was undertaken to characterize the incidence, clinical manifestations and hospitalization among AID affected by COVID-19 and to analyze the association between immunomodulatory medication and these outcomes. Clinical, demographic, maintenance treatment, symptoms and disease course data and outcomes of AID patients with COVID-19 infection were assessed via an online survey tool and printed copy from 1 January till February 28, 2023.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!