ArticleLupus science & medicine2022
Hydroxychloroquine PK and exposure-response in pregnancies with lupus: the importance of adherence for neonatal outcomes.
Article in Lupus science & medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Effect of hydroxychloroquine on pregnancy outcome in patients with SLE: a systematic review and meta-analysis.Lupus science & medicine · 2024Pooled it
- Pharmacokinetics of hydroxychloroquine in paediatric lupus: data from a novel, direct-to-family clinical trial.Lupus science & medicine · 2022Trial
- Racial differences in cardiovascular events and adverse pregnancy outcomes among pregnant individuals with SLE.Lupus science & medicine · 2026Article
- Pharmacokinetics of Certolizumab Pegol in Pregnancy: Results from the Open-Label CHERISH Study.Rheumatology and therapy · 2026Article
- Real-World Longitudinal Data on the Impact of Hydroxychloroquine Blood Level Monitoring on Lupus Outcomes: Results of a Prospective Longitudinal Cohort Study.Arthritis care & research · 2026Article
- Immune microenvironment dynamics in pregnant patients with concomitant autoimmune diseases: mechanisms, challenges, and clinical significance.Military Medical Research · 2026Review
- Lupus nephritis.Nature reviews. Disease primers · 2025Review
- Pregnancy-associated exposure reduction to medications used for antiphospholipid syndrome: a systematic review.EULAR rheumatology open · 2025Article
- Understanding the Pathophysiology of Preeclampsia: Exploring the Role of Antiphospholipid Antibodies and Future Directions.Journal of clinical medicine · 2024Review
- Interpreting hydroxychloroquine blood levels for medication non-adherence: a pharmacokinetic study.Lupus science & medicine · 2024Article
- Azathioprine metabolite levels and outcomes during pregnancies with rheumatic disease.Lupus science & medicine · 2024Article
- Lupus nephritis: management challenges during pregnancy.Frontiers in nephrology · 2024Review
- Article
- The Impact of Hydroxychloroquine on Primary Feto-Placental Endothelial Cells from Healthy and Early-Onset Preeclamptic Placentas.International journal of molecular sciences · 2023Article
- Pharmacokinetics of Ceftazidime-Avibactam in Combination with Aztreonam (COMBINE) in a Phase 1, Open-Label Study of Healthy Adults.Antimicrobial agents and chemotherapy · 2022Article
- The association of lupus nephritis with adverse pregnancy outcomes among women with lupus in North America.Lupus · 2022Article
- Dialogue: Hydroxychloroquine pharmacokinetic (PK) and exposure response in pregnancies with systemic lupus erythematosus: the importance of adherence for neonatal outcome.Lupus science & medicine · 2022Article
- Increased risk of early-onset childhood systemic lupus erythematosus for children born to affected parents: A nationwide child-parent cohort study.Frontiers in immunology · 2022Article
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8 authors at 3 institutions in 2 countries.
Funding
Abstract
objectiveEvaluate the impact of pregnancy physiology and medication non-adherence on serum hydroxychloroquine (HCQ) pharmacokinetics (PK) and exposure-response in SLE.
methodsWe conducted a PK analysis using data from two observational pregnancy registries. We enrolled pregnant women with SLE taking HCQ at least 3 months prior to, and throughout pregnancy, and excluded those with multiple gestations. Using the PK model, we conducted dosing simulations and imputed 0%/20%/40%/60% non-adherence to evaluate the impact of adherence versus physiological changes on HCQ concentrations. We compared the effect of pregnancy-average non-adherent concentrations (≤100 ng/mL vs >100 ng/mL) on preterm birth using adjusted logistic regression.
resultsWe enrolled 56 women who had 61 pregnancies. By the third trimester, mean apparent HCQ clearance increased by 59.6%. At a dosage of 400 mg/day, fully adherent patients are expected to have HCQ concentrations ≤100 ng/mL only 0.3% of the time, compared with 24.2% when 60% of doses are missed. Persistently low HCQ concentrations throughout pregnancy were associated with a significantly higher odds of preterm birth, controlling for lupus nephritis and race (OR 11.2; 95% CI 2.3 to 54.2; p=0.003).
conclusionsWe observed significant changes in HCQ PK during pregnancy, resulting in a shortening in the drug's half-life by 10 days; however, medication non-adherence had a more pronounced effect on HCQ exposure compared with physiological changes alone. Moreover, pregnant women with non-adherent HCQ concentrations had significantly higher rates of preterm birth. Accordingly, optimising adherence in pregnancy may be more clinically meaningful than adjusting HCQ dosage to account for physiological changes. PK modelling indicates that serum HCQ concentrations ≤100 ng/mL are suggestive of non-adherence regardless of trimester and may help identify pregnancies at risk for poor outcomes.
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