Evidence map›Paper›PMID 26428205›Full record

ArticleThe Journal of rheumatology2015

Hydroxychloroquine Blood Levels in Systemic Lupus Erythematosus: Clarifying Dosing Controversies and Improving Adherence.

Laura Durcan, William A Clarke, Laurence S Magder, Michelle Petri

Open access · bronzeAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of rheumatology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 108 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
108citing papers in PubMed, 4 pooled it
12.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

108 citing papers in PubMed, 4 syntheses or guidelines pooled it, 186 citations in OpenAlex.

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48 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 1 country.

Laura DurcanFrom the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine.
William A ClarkeFrom the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine.
Laurence S MagderFrom the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine.
Michelle PetriFrom the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine.
Johns Hopkins Hospital · USJohns Hopkins Medicine · USUniversity of Maryland, College Park · US

Funding

Lupus CohortR01AR043727 · NIAMS · JOHNS HOPKINS UNIVERSITY · PI PETRI, MICHELLE A · 1997 to 2015
$8.2M
NIAMS NIH HHS R01 AR043727NIAMS NIH HHS R0-1 AR 43727
6 · The paper itself

Abstract

objectiveHydroxychloroquine (HCQ) is used for its effect on systemic lupus erythematosus (SLE) disease activity and longterm benefits. This can be limited by adherence. One way to assess adherence is to measure blood levels. Conflicting data exist regarding blood levels and disease activity. There is disagreement about dosing; rheumatologists recommend weight-based dosing while some other specialists advocate height-based "ideal body weight" dosing.

methodsPatients were prescribed HCQ not exceeding 6.5 mg/kg (max 400 mg/day). In hemodialysis, the dose was 200 mg after each session, and in renal insufficiency it was 200 mg/day. Levels were measured at each visit with a therapeutic range of 500-2000 ng/ml. Patients were divided according to baseline blood level. To assess the effect of measurement and counseling on adherence, we compared the proportion of patients with a level of 500 ng/ml or higher based on the number of prior assessments.

resultsThe proportion of patients with HCQ levels in the therapeutic range differed significantly by age, sex, and Vitamin D level. There was a trend toward lower levels with renal failure. Blood levels were similar regardless of height and ideal body weight. Comparing those with undetectable, subtherapeutic, and therapeutic levels, disease activity decreased (SLE Disease Activity Index 2.92, 2.36, and 2.20, p = 0.04 for trend). At first, 56% were therapeutic, and by the third measurement this increased to 80% (p ≤ 0.0001).

conclusionThere was a trend toward higher disease activity with lower HCQ levels. Renal failure dosing led to suboptimum levels. We show that weight-based dosing (max 400 mg daily) is appropriate and that height does not appear to influence levels. Measurement, counseling, and repeated testing can increase adherence rates.

Indexed as

Drug MonitoringAcademic Medical CentersAdultAge FactorsAnalysis of VarianceCohort StudiesDose-Response Relationship, DrugDrug Administration ScheduleFemaleFollow-Up StudiesHumansHydroxychloroquineLupus Erythematosus, SystemicMaleMaximum Tolerated DoseMiddle AgedHydroxychloroquineADHERENCEDISEASE ACTIVITYHYDROXYCHLOROQUINESLE

Identifiers

PMID26428205
PMCPMC4630115
OpenAlexW2301233665

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.