ArticleLupus science & medicine2023
Hydroxychloroquine daily dose, hydroxychloroquine blood levels and the risk of flares in patients with systemic lupus erythematosus.
Article in Lupus science & medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Saudi National Clinical Practice Guidelines for Management of Adult Systemic Lupus Erythematosus.Current rheumatology reviews · 2025Guideline
- Hydroxychloroquine levels in pregnancy and materno-fetal outcomes in systemic lupus erythematosus patients.Rheumatology (Oxford, England) · 2025Trial
- 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
- Long-term outcomes of hydroxychloroquine dose reduction in Puerto Ricans with systemic lupus erythematosus: 6-year follow-up.Lupus science & medicine · 2026Article
- Review
- Use of hydroxychloroquine to treat patients with IgA nephropathy and time to accelerated glucocorticoid tapering.BMC nephrology · 2026Article
- Associations between hydroxychloroquine dose and risk of flares in systemic lupus erythematosus.BMC rheumatology · 2025Article
- A Case Series and Review of Hydroxychloroquine Toxicity and Monitoring: How Do We Dose Hydroxychloroquine?Cureus · 2025Article
- Refining lupus management: a comprehensive review of HCQ blood levels.Rheumatology advances in practice · 2025Review
- Hydroxychloroquine blood concentrations and effects in Chinese patients with IgA nephropathy.Journal of nephrology · 2024Article
- Hydroxychloroquine as an Adjunct Therapy for Diabetes in Pregnancy.International journal of molecular sciences · 2024Review
- Urinary methotrexate dosage in rheumatoid arthritis, in patients treated for at least 6 months: a potential marker of adherence.RMD open · 2024Article
- Reference Range of Hydroxychloroquine Blood Levels That Can Reduce Odds of Active Lupus and Prevent Flares.Arthritis care & research · 2024Article
- Therapeutic Drug Monitoring in Patients with Systemic Lupus Erythematosus: Utility and Gaps.Journal of clinical medicine · 2024Review
- Analysis of Factors Influencing Whole Blood Hydroxychloroquine Concentration in Patients with Systemic Lupus Erythematosus in China.Rheumatology and therapy · 2023Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRecent guidelines for SLE recommend using a hydroxychloroquine (HCQ) dose less than 5.0 mg/kg/day to reduce the risk of retinopathy. To determine if this dose reduction would have an impact on the clinical course of SLE, we compared flare incidence in a cohort of patients with SLE treated with two different oral HCQ dosages (≤5 mg/kg/day or >5 mg/kg/day). As a secondary analysis, we compared HCQ blood levels between the two different oral dosages, and evaluated the frequency of non-adherence in patients with SLE treated with HCQ.
methodsWe identified a cohort of patients with SLE taking HCQ for at least 6 months and followed for 24 months. At study entry and 6 months later, a blood venous sample was taken to measure HCQ blood levels by liquid chromatography. Incidence of new SLE flares after recruitment was put in relation to daily HCQ dose and mean HCQ blood levels. Cox regression analysis served to identify factors associated with SLE flares.
results83 patients were enrolled. We observed 11 (16%) flares that developed in mean 14.8 months of follow-up. The difference in terms of flare rate and mean HCQ blood levels between the two oral dosages was not statistically significant. There was a trend (p=0.08) for high HCQ dose being associated with a lower flare rate. At Cox analysis, higher HCQ blood levels and older age at baseline were protective against flare occurrence, while concomitant immunosuppressant therapy showed significant positive association. HCQ blood levels did not correlate with prescribed HCQ dose.
conclusionPatients with low oral HCQ dosage tend to have more flares, although the difference was not statistically significant. Higher HCQ blood levels were protective against flare occurrence. The risks and benefits must be balanced in choosing HCQ dose.
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