IMPACT OF SYSTEMIC LUPUS DISEASE ACTIVITY STATE ON FLARE RISK AFTER HYDROXYCHLOROQUINE MAINTENANCE, REDUCTION OR DISCONTINUATION IN A MULTINATIONAL INCEPTION COHORT
Authors: C. Brasil et al.
The study evaluated how disease activity status is associated with SLE flare after HCQ reduction or discontinuation, compared with HCQ maintenance. Prospective data from the SLICC cohort, an inception cohort, which enrolls patients within 15 months of diagnosis and follows them annually were analyzed. A total of 1460 patients were included. We estimated that 5% of patients may have reduced HCQ therapy as result of the AAO guidelines, 55% because of low disease activity state, and the remainder (40%) for other reasons (possibly intolerance or patient preference). Among those who discontinued HCQ, 4% had retinal changes of concern, 15% were in clinical remission and the remainder stopped for unknown reasons (possibly intolerance, or patient preference). Maintaining HCQ was associated with a lower flare risk in all subgroups evaluated. Even among SLE patients in remission, lowering or stopping HCQ was associated with a 2-fold increase in flare risk compared to HCQ maintenance.
This study suggests that all SLE patients should be maintained on HCQ regardless of SLE activity, unless in the very few cases in which there is true HCQ intolerance.