COMPARISON OF FLARES IN 85 PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS, WHO DISCONTINUED, REDUCED DOSE OR MAINTAINED HYDROXYCHLOROQUINE DURING A PROSPECTIVE STUDY OF OPHTHALMOLOGICAL SCREENING FOR RETINOPATHY
Abstract: AB1771-HPR (2023)
Authors: J. Marques Dias et al.
Hydroxychloroquine (HCQ) is associated with ophthalmologic long term side effects. Little is known on the risk of SLE flares associated with HCQ reduction or cessation following ophthalmologic screening.
85 SLE patients included in the prospective PERFOCTAPS study and treated with HCQ for at least 5 years were studied. Patients were divided in three groups: group maintenance corresponding to patients with no ophthalmological alterations maintaining their treatment at the same dose, group reduction corresponding to patients with mild ophthalmological alterations that led to reduction of HCQ dose (n=20), and group discontinuation corresponding to patients with retinal abnormalities that led to stopping HCQ (n=5). Occurrence of flares (SELENA-SLEDAI flare index) was assessed in the two years following HCQ reduction or discontinuation.
There was no significant difference in HCQ dose (mg/kg/day) between the three groups. The mean dose of HCQ was 5.6±1.8 mg/kg/day. Flares occurred in 28.3% in the maintenance group, 50% in the reduction group, and 40% in the discontinuation group. After adjustments on potential confounders, HCQ reduction was independently associated with the risk of flare (adjusted HR 2.57). The same trend was observed in the discontinuation group but without reaching statistical significance (adjusted HR 3.03).
This adds data to the large body of data rendering HCQ the anchor drug of SLE patients. HCQ dose reduction should always be balanced against the risk of SLE flares and subsequent need for rescue drugs (corticosteroids et cetera).