ArticleLupus science & medicine2024
Interpreting hydroxychloroquine blood levels for medication non-adherence: a pharmacokinetic study.
Article in Lupus science & medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Increasing the utilisation of hydroxychloroquine blood level testing in lupus: a quality improvement project.Lupus science & medicine · 2026Article
- Defining Optimally Safe and Effective Blood Levels of Hydroxychloroquine in Lupus: An Important Step Toward Precision Drug Monitoring.Arthritis & rheumatology (Hoboken, N.J.) · 2026Observational
- Redefining Difficult-to-Treat Systemic Lupus Erythematosus: Biomarkers of Molecular Refractoriness Beyond Clinical Failure.International journal of molecular sciences · 2026Review
- 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
- Toward Optimal Dosing in Systemic Lupus Erythematosus: The Case for Hydroxychloroquine Blood Level Monitoring.Arthritis care & research · 2026Article
- Relationship between hydroxychloroquine blood levels and lupus activity through the lens of the type 1 and type 2 lupus model: a cross-sectional study.Lupus science & medicine · 2025Article
- Refining lupus management: a comprehensive review of HCQ blood levels.Rheumatology advances in practice · 2025Review
- Effect of an Electronic Pill Bottle on Hydroxychloroquine Adherence in Pediatric Lupus: Results of a Novel Direct-to-Family Pilot Trial.ACR open rheumatology · 2025Article
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Authors and funding
11 authors.
Funding
Abstract
objectiveCharacterise the relationship between hydroxychloroquine (HCQ) blood levels and the number of missed doses, accounting for dosage, dose timing and the large variability in pharmacokinetics (PK) between patients.
methodsWe externally validated a published PK model and then conducted dosing simulations. We developed a virtual population of 1000 patients for each dosage across a range of body weights and PK variability. Using the model, 10 Monte Carlo simulations for each patient were conducted to derive predicted whole blood concentrations every hour over 24 hours (240 000 HCQ levels at steady state). To determine the impact of missed doses on levels, we randomly deleted a fixed proportion of doses.
resultsFor patients receiving HCQ 400 mg daily, simulated random blood levels <200 ng/mL were exceedingly uncommon in fully adherent patients (<0.1%). In comparison, with 80% of doses missed, approximately 60% of concentrations were <200 ng/mL. However, this cut-off was highly insensitive and would miss many instances of severe non-adherence. Average levels quickly dropped to <200 ng/mL after 2-4 days of missed doses. Additionally, mean levels decreased by 29.9% between peak and trough measurements.
conclusionsWe propose an algorithm to optimally interpret HCQ blood levels and approximate the number of missed doses, incorporating the impact of dosage, dose timing and pharmacokinetic variability. No single cut-off has adequate combinations of both sensitivity and specificity, and cut-offs are dependent on the degree of targeted non-adherence. Future studies should measure trough concentrations to better identify target HCQ levels for non-adherence and efficacy.
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