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Peña-Vizcarra ÓR, Zavala-Miranda MF, Juárez-Cuevas B, Márquez-Macedo SE, Hernández-Andrade A, Nordmann-Gomes A, Pérez-Arias AA, Morales-Buenrostro LE, Mejía-Vilet JM. Effect of antimalarials on clinical outcomes in lupus nephritis. Rheumatology (Oxford) 2024; 63:2230-2238. [PMID: 37930870 DOI: 10.1093/rheumatology/kead576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/26/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVES To evaluate the effect of antimalarial drugs in response to therapy, incidence of LN flares, and progression of kidney disease in a large LN cohort. METHODS We retrospectively studied 424 biopsy-proven LN patients followed for >3 years. We obtained demographic, clinical, laboratory, histopathological and treatment variables. Antimalarial use was approached as (i) users vs no users, (ii) according to prevalent vs incident use regarding the LN flare and (iii) according to the type of antimalarial. All outcomes were evaluated by time-to-event analyses. Adjusted hazard ratios were obtained by Cox regression. RESULTS The cohort included 424 patients, median age of 29 years (IQR 23-37), 96% female, with a median eGFR of 81 ml/min/1.73 m2 (IQR 48-118) and proteinuria of 3.4 g/g (IQR 1.9-5.5). Antimalarial use was associated with higher complete response (aHR 1.57, 1.08-2.27), lower incidence of kidney flares (aHR 0.63, 0.43-0.92) and lower progression to kidney failure (aHR 0.37, 0.23-0.53). The effect of antimalarials on these outcomes was modified by the presentation eGFR, histological class and/or concomitant initial immunosuppressor. These protective effects were observed in patients with prevalent or incident use regarding the LN flare and patients using hydroxychloroquine. The incidence of toxic retinopathy was 1.7%, 5.7% and 8.8% by 3, 5 and 7 years of continued antimalarial use, respectively. CONCLUSION The use of antimalarial drugs is associated with increased response to therapy, lower incidence of kidney flares, and lower progression to kidney failure in LN patients. Conversely, this population is at high risk of toxic maculopathy, and yearly ophthalmologic examination is recommended.
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Affiliation(s)
- Óscar R Peña-Vizcarra
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Fernanda Zavala-Miranda
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bernardo Juárez-Cuevas
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sofía E Márquez-Macedo
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Adriana Hernández-Andrade
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alberto Nordmann-Gomes
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Abril A Pérez-Arias
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis E Morales-Buenrostro
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan M Mejía-Vilet
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Yang T, Shi Y, Wang Y, Feng Y, Shao Q, Jiang C, Wang L, Liu J. Hydroxychloroquine blood concentrations and effects in Chinese patients with IgA nephropathy. J Nephrol 2024:10.1007/s40620-024-02029-z. [PMID: 39048780 DOI: 10.1007/s40620-024-02029-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Hydroxychloroquine (HCQ) is recommended for Chinese patients with immunoglobulin A nephropathy (IgAN). However, the relationship between HCQ blood concentration and the therapeutic effect for IgAN has not yet been defined. This study investigates the optimal and efficacious range of HCQ blood concentrations in Chinese patients with IgAN. METHODS Seventy-three patients with biopsy-proven IgAN who were at risk of progression were included in this study. Thirty-eight patients with IgAN were treated with HCQ plus an optimized renin-angiotensin-aldosterone system inhibitor (RAASi), and thirty-five patients received only RAASi. Blood HCQ concentration and 24-h proteinuria were examined at three and six months after treatment. RESULTS The baseline proteinuria levels were comparable between the RAASi and HCQ groups. The HCQ group had lower 24-h proteinuria than the RAASi group three months after treatment, though the difference was not significant (p = 0.38). After six months, the median proteinuria level was significantly lower in the HCQ group than in the RAASi group (p < 0.05). The percentage reduction in 24-h proteinuria in the HCQ group was greater than that in the RAASi group at three (p < 0.05) and six months (p < 0.05). Hydroxychlorquine blood concentration and efficacy were positively correlated at three months (r = 0.428, p < 0.05) and six months (r = 0.48, p < 0.05). Moreover, the optimal blood concentration of HCQ for three-month efficacy was 418.96 ng/mL and that for six-month efficacy was 582.48 ng/mL. No serious adverse events were reported during HCQ treatment. CONCLUSIONS Hydroxyhloroquine safely reduces proteinuria in Chinese patients with IgAN. The efficacy of HCQ is positively correlated with its blood concentration.
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Affiliation(s)
- Ting Yang
- Department of Nephrology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Department of Pharmacy, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Yaotong Shi
- Department of Nephrology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Department of Nephrology, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Zhenjiang, China
| | - Ye Wang
- Department of Pharmacy, Nanjing Brain Hospital, Nanjing, China
| | - Yuan Feng
- Department of Nephrology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Qiuyuan Shao
- Department of Nephrology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Chunming Jiang
- Department of Nephrology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Lulu Wang
- Department of Nephrology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China.
- Department of Pharmacy, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China.
| | - Jing Liu
- Department of Nephrology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China.
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Teboul A, Arnaud L, Chasset F. Recent findings about antimalarials in cutaneous lupus erythematosus: What dermatologists should know. J Dermatol 2024; 51:895-903. [PMID: 38482997 DOI: 10.1111/1346-8138.17177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 07/04/2024]
Abstract
Antimalarials (AMs), particularly hydroxychloroquine (HCQ) and chloroquine (CQ), are the cornerstone of the treatment for both systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE). HCQ and CQ are recommended as first-line oral agents in all CLE guidelines. Initially thought to have potential therapeutic effects against COVID-19, HCQ has drawn significant attention in recent years, highlighting concerns over its potential toxicity among patients and physicians. This review aims to consolidate current evidence on the efficacy of AMs in CLE. Our focus will be on optimizing therapeutic strategies, such as switching from HCQ to CQ, adding quinacrine to either HCQ or CQ, or adjusting HCQ dose based on blood concentration. Additionally, we will explore the potential for HCQ dose reduction or discontinuation in cases of CLE or SLE remission. Our review will focus on the existing evidence regarding adverse events linked to AM usage, with a specific emphasis on severe events and those of particular interest to dermatologists. Last, we will discuss the optimal HCQ dose and the balance between preventing CLE or SLE flares and minimizing toxicity.
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Affiliation(s)
- Alexandre Teboul
- Dermatology and Allergology Department, Faculty of Medicine, Tenon Hospital, Sorbonne University, Paris, France
| | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Autoimmune diseases (RESO), Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM UMR-S 1109, Strasbourg, France
| | - François Chasset
- Dermatology and Allergology Department, Faculty of Medicine, Tenon Hospital, Sorbonne University, Paris, France
- INSERM U1135, CIMI, Paris, France
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4
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Yazdany J, Shiboski S, Schmajuk G. The Hydroxychloroquine Conundrum: Striking the Right Balance Between Safety and Efficacy in Rheumatology Practice. Arthritis Rheumatol 2024. [PMID: 38923852 DOI: 10.1002/art.42930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Jinoos Yazdany
- University of California, San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California
| | | | - Gabriela Schmajuk
- University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California
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Askanase AD, Furie RA, Dall'Era M, Bomback AS, Schwarting A, Zhao MH, Bruce IN, Khamashta M, Rubin B, Carroll A, Daniels M, Levy RA, van Vollenhoven R, Urowitz MB. Disease-modifying therapies in systemic lupus erythematosus for extrarenal manifestations. Lupus Sci Med 2024; 11:e001124. [PMID: 38777595 PMCID: PMC11116871 DOI: 10.1136/lupus-2023-001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Our 2022 published working definition of disease modification in systemic lupus erythematosus (SLE) was 'minimising disease activity with the fewest treatment-associated toxicities and slowing or preventing organ damage progression'. The objective of this review was to classify current SLE treatments according to the proposed non-renal disease modification criteria excluding toxicities. Based on a review of select clinical trial (n=32) and observational study (n=54) publications for 14 SLE medications across different therapeutic classes, and the authors' clinical experience, we evaluated disease modification potential as per the proposed framework at three time points. Specific criteria used to determine disease modification potential included a drug's capacity to reduce: (1) non-renal disease activity, (2) severe flares, (3) use of steroids/immunosuppressants and (4) organ damage accrual. Criteria 1-3 were assessed at 1 year and 2-5 years and, when positive, were considered evidence for disease modification potential; criterion 4 was used to confirm disease modification at >5 years. Each treatment received one of four mutually exclusive designations at each time point: (a) criterion met, (b) indications of criterion met despite insufficient evidence in the literature, (c) inconclusive and (d) no available supportive data. This review excludes an assessment of potential toxicities. Eight of the 14 SLE treatments met ≥1 disease modification criteria up to year 5. Hydroxychloroquine improved overall survival at >5 years, suggesting long-term disease modification, but no data on specific organ systems were reported. Belimumab was the only treatment to meet all criteria. Belimumab and hydroxychloroquine met disease modification definitions across three time points. Evidence for other SLE therapies was incomplete, particularly at >5 years. Future studies are warranted for other treatments to meet the disease modification criteria. We discuss challenges to classification and possible updates to our published criteria.
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Affiliation(s)
- Anca D Askanase
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Richard A Furie
- Division of Rheumatology, Northwell Health, Great Neck, New York, USA
| | - Maria Dall'Era
- Division of Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Andrew S Bomback
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Andreas Schwarting
- Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany
- University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ming-Hui Zhao
- Renal Division, Peking University First Hospital, Beijing, China
| | - Ian N Bruce
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | - Bernie Rubin
- US Medical Affairs, GSK, Research Triangle Park, North Carolina, USA
| | - Angela Carroll
- US Medical Affairs, GSK, Research Triangle Park, North Carolina, USA
| | | | - Roger Abramino Levy
- Specialty Care, Global Medical Affairs, GlaxoSmithKline, Philadelphia, Pennsylvania, USA
| | - Ronald van Vollenhoven
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center and Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Murray B Urowitz
- Professor Emeritus, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Peng-Cheng L, Meng-Na L, Jian-Bin L, Shu-Jiao Y, Wu R. Advancements on the impact of hydroxychloroquine in systemic lupus erythematosus. Heliyon 2024; 10:e30393. [PMID: 38711668 PMCID: PMC11070867 DOI: 10.1016/j.heliyon.2024.e30393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024] Open
Abstract
Hydroxychloroquine (HCQ) has gained significant attention as a therapeutic option for systemic lupus erythematosus (SLE) because of its multifaceted mechanism of action. It is a lipophilic, lysosomotropic drug, that easily traverses cell membranes and accumulates in lysosomes. Once accumulated, HCQ alkalizes lysosomes within the cytoplasm, thereby disrupting their function and interfering with processes like antigen presentation. Additionally, HCQ has shown potential in modulating T-cell responses, inhibiting cytokine production, and influencing Toll-like receptor signaling. Its immunomodulatory effects have generated interest in its application for autoimmune disorders. Despite its established efficacy, uncertainties persist regarding the optimal therapeutic concentrations and their correlation with adverse effects such as retinal toxicity. Therefore, standardized dosing and monitoring guidelines are crucial. In this study, we provide a comprehensive review of the mechanisms, efficacy, dosing variations, and retinal toxicity profiles of HCQ, which are essential to optimize SLE treatment protocols and ensure patient safety.
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Affiliation(s)
- Liu Peng-Cheng
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Lv Meng-Na
- The First Clinical Medical College of Nanchang University, Nanchang, China
| | - Li Jian-Bin
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yu Shu-Jiao
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Rui Wu
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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7
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He Y, Fan Y, Ahmadpoor X, Wang Y, Li ZA, Zhu W, Lin H. Targeting lysosomal quality control as a therapeutic strategy against aging and diseases. Med Res Rev 2024. [PMID: 38711187 DOI: 10.1002/med.22047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 04/04/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024]
Abstract
Previously, lysosomes were primarily referred to as the digestive organelles and recycling centers within cells. Recent discoveries have expanded the lysosomal functional scope and revealed their critical roles in nutrient sensing, epigenetic regulation, plasma membrane repair, lipid transport, ion homeostasis, and cellular stress response. Lysosomal dysfunction is also found to be associated with aging and several diseases. Therefore, function of macroautophagy, a lysosome-dependent intracellular degradation system, has been identified as one of the updated twelve hallmarks of aging. In this review, we begin by introducing the concept of lysosomal quality control (LQC), which is a cellular machinery that maintains the number, morphology, and function of lysosomes through different processes such as lysosomal biogenesis, reformation, fission, fusion, turnover, lysophagy, exocytosis, and membrane permeabilization and repair. Next, we summarize the results from studies reporting the association between LQC dysregulation and aging/various disorders. Subsequently, we explore the emerging therapeutic strategies that target distinct aspects of LQC for treating diseases and combatting aging. Lastly, we underscore the existing knowledge gap and propose potential avenues for future research.
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Affiliation(s)
- Yuchen He
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yishu Fan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xenab Ahmadpoor
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yumin Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhong Alan Li
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Shatin, NT, Hong Kong SAR, China
| | - Weihong Zhu
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hang Lin
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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8
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Paredes-Ruiz D, Martin-Iglesias D, Ruiz-Irastorza G. Balancing risks and benefits in the use of hydroxychloroquine and glucocorticoids in systemic lupus erythematosus. Expert Rev Clin Immunol 2024; 20:359-373. [PMID: 38112074 DOI: 10.1080/1744666x.2023.2294938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Hydroxychloroquine (HCQ) and glucocorticoids (GCs) constitute the oldest and more used drugs in the treatment of systemic lupus erythematosus (SLE). Despite this long experience, both are still subject to a number of uncertainties, mainly regarding the dose. AREAS COVERED We review the main mechanisms of action, the clinical and toxic effects of HCQ and GCs and analyze the recommendations for the use of both in guidelines published since 2018. We offer a set of recommendations based on the pharmacology, mechanisms of action and clinical evidence. EXPERT OPINION HCQ is the backbone therapy for SLE, and a judicious use must be accomplished, using doses that allow a good control of lupus without compromising the safety of treatments very much prolonged over the time. Stable doses of 200 mg/day seem to accomplish both conditions. GCs should be used more judiciously, with methyl-prednisolone pulses as the main therapy for inducing rapid remission and doses ≤5-2.5 mg/day be never exceeded in long-term maintenance treatments.
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Affiliation(s)
- Diana Paredes-Ruiz
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, The Basque Country, Spain
| | - Daniel Martin-Iglesias
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, The Basque Country, Spain
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, The Basque Country, Spain
- Department of Medicine, University of the Basque Country, The Basque Country, Spain
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9
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Liu PC, Luo SL, Lv MN, Wang Y, Li JB, Yu SJ, Wu R. Effect of hydroxychloroquine blood concentration on the efficacy and ocular toxicity of systemic lupus erythematosus. Sci Rep 2024; 14:7674. [PMID: 38561370 PMCID: PMC10984965 DOI: 10.1038/s41598-024-58391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
In the absence of evidence-based guidance on the impact of hydroxychloroquine (HCQ) blood concentration on efficacy and ocular toxicity in systemic lupus erythematosus (SLE), the clinical monitoring of HCQ blood concentration is not yet widely performed, which raised concerns about the necessity of conducting HCQ blood concentration monitoring. In this retrospective study, we consecutively enrolled 135 patients with SLE who received HCQ treatment for more than 6 months from July 2022 to December 2022. Ocular toxicity was evaluated by collecting relevant retinal parameters using optical coherence tomography angiography (OCTA). Therapeutic efficacy was evaluated using the SLE disease activity index (SLEDAI) and relevant clinical parameters. HCQ blood concentration was determined by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Spearman correlation analysis revealed that the cumulative dose of HCQ was positively correlated with the foveal avascular zone (FAZ) perimeter and FAZ area (r = 0.734, P < 0.001; r = 0.784, P < 0.001). Meanwhile, the treatment duration of HCQ was positively correlated with FAZ perimeter and FAZ area (r = 0.761, P < 0.001; r = 0.882, P < 0.001). The univariate and multivariate logistic regression analyses indicated that HCQ blood concentration was associated with the disease activity of patients with SLE (odds ratio 0.994, 95% CI 0.990-0.999). HCQ blood concentration may be an important factor in assessing the therapeutic effectiveness of SLE patients. The HCQ-related ocular toxicity was a long-term effect related to long term exposure, rather than the blood concentration of HCQ at the time of testing. More importantly, when addressing HCQ-related ocular toxicity, it may be crucial to pay attention to the cumulative dose and treatment duration of HCQ.
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Affiliation(s)
- Peng-Cheng Liu
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Shui-Lin Luo
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Meng-Na Lv
- The First Clinical Medical College of Nanchang University, Nanchang, China
| | - Yan Wang
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jian-Bin Li
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Shu-Jiao Yu
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Rui Wu
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
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Garg S, Chewning B, Hutson P, Astor BC, Bartels CM. Reference Range of Hydroxychloroquine Blood Levels That Can Reduce Odds of Active Lupus and Prevent Flares. Arthritis Care Res (Hoboken) 2024; 76:241-250. [PMID: 37667434 DOI: 10.1002/acr.25228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/04/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Recent data show that lower hydroxychloroquine (HCQ) doses are associated with a two- to six-fold higher risk of lupus flares. Thus, establishing an effective reference range of HCQ blood levels with upper and lower bounds for efficacy may support individualizing HCQ dosing to prevent flares. METHODS HCQ levels in whole blood and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) were measured during the baseline visit and again during a standard of care routine follow-up visit. Active cross-sectional lupus at baseline was defined as SLEDAI ≥6; a within subject flare was defined as a subsequent three-point increase in SLEDAI with clinical symptoms requiring therapy change. We examined associations between active lupus and HCQ blood levels at baseline and flares and HCQ levels during 6 to 12-month routine lupus follow-up visits using mixed regression analysis. RESULTS Among 158 baseline patient visits, 19% had active lupus. Odds of active lupus were 71% lower in patients with levels within a 750 to 1,200 ng/mL range (adjusted odds ratio 0.29, 95% confidence interval 0.08-0.96). Using convenience sampling strategy during a pandemic, we longitudinally followed 42 patients. Among those patients, 17% flared during their follow-up visit. Maintaining HCQ levels within 750 to 1,200 ng/mL reduced the odds of a flare by 26% over a nine-month median follow-up. CONCLUSION An effective reference range of HCQ blood levels, 750 to 1,200 ng/mL, was associated with 71% lower odds of active lupus, and maintaining levels within this range reduced odds of flares by 26%. These findings could guide clinicians to individualize HCQ doses to maintain HCQ levels within this range to maximize efficacy.
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Affiliation(s)
- Shivani Garg
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Paul Hutson
- University of Wisconsin School of Pharmacy, Madison
| | - Brad C Astor
- University of Wisconsin School of Medicine and Public Health, Madison
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11
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Pan M, Jin R, Dai Y, Gao B, Liu Y, Peng X, Qiao J, Shuai Z. The presumable effects of hydroxychloroquine and its metabolites in the treatment of systemic lupus erythematosus. Int Immunopharmacol 2024; 126:111269. [PMID: 38006753 DOI: 10.1016/j.intimp.2023.111269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE Hydroxychloroquine (HCQ) is an essential drug in the treatment of systemic lupus erythematosus (SLE). This study aimed to detect the concentrations of HCQ and its metabolites from peripheral blood of SLE patients and to investigate the relationship between those concentrations and SLE disease activity. METHODS 176 SLE patients treated with HCQ were enrolled in this study. The concentrations of HCQ and its metabolites in their peripheral blood were measured by high-performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). Patients' disease activity was evaluated with the systemic lupus erythematosus disease activity index (SLEDAI). The variables between different concentrations or treatments were statistically analyzed. Linear regression was employed to explore relationships between the concentrations of HCQ and its metabolites with the disease activity. RESULTS The SLEDAI was lower in patients with higher concentrations of HCQ, desethylhydroxychloroquine (DHCQ), and desethylchloroquine (DCQ) (P = 0.024, P = 0.018, and P = 0.003, respectively). There were no significant differences in SLEDAI and the concentrations of HCQ and its metabolites among groups with different treatments (P > 0.05). After adjusting age, gender, disease duration, HCQ dose adjusted to actual body weight, and glucocorticoid (GC) dose, the SLEDAI was negatively correlated with the concentrations of HCQ, DHCQ, DCQ and bisdesethylchloroquine (BDCQ) (P = 0.007, P = 0.011, P = 0.029, and P = 0.008, respectively). After grouping analysis, in patients treated with HCQ and GC, the SLEDAI was negatively correlated with concentrations of HCQ, DHCQ and BDCQ (P = 0.011, P = 0.035, and P = 0.036, respectively). CONCLUSIONS The concentrations of HCQ and metabolites were correlated with the SLE disease activity after adjusting possible confounding factors, indicating that HCQ and its metabolites might play certain immunoregulatory roles in SLE treatment. Moreover, GC might have a synergistic effect with HCQ. It is helpful in clinical management and follow-up to monitor the concentrations of HCQ and its metabolites in SLE patients.
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Affiliation(s)
- Menglu Pan
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
| | - Ruimin Jin
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
| | - Yaqian Dai
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
| | - Beibei Gao
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
| | - Yue Liu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
| | - Xinchen Peng
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
| | - Jinping Qiao
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China.
| | - Zongwen Shuai
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui Province 230032, China.
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12
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Hooda U, Feola N, Nabors C, Dhand A. Arrhythmias in Patients With Coronavirus Disease 2019 Treated With Hydroxychloroquine and/or Azithromycin. Am J Ther 2024; 31:e57-e59. [PMID: 33852488 DOI: 10.1097/mjt.0000000000001361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Abhay Dhand
- Departments of Medicine
- Transplant Infectious Diseases, Westchester Medical Center/New York Medical College, Valhalla, NY
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13
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Nguyen Y, Blanchet B, Urowitz MB, Hanly JG, Gordon C, Bae S, Romero‐Diaz J, Sanchez‐Guerrero J, Clarke AE, Bernatsky S, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Ramsey‐Goldman R, Manzi S, Jönsen A, Alarcón GS, Van Vollenhoven RF, Aranow C, Le Guern V, Mackay M, Ruiz‐Irastorza G, Lim SS, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askanase A, Buyon J, Costedoat‐Chalumeau N. Association Between Severe Nonadherence to Hydroxychloroquine and Systemic Lupus Erythematosus Flares, Damage, and Mortality in 660 Patients From the SLICC Inception Cohort. Arthritis Rheumatol 2023; 75:2195-2206. [PMID: 37459273 PMCID: PMC10792124 DOI: 10.1002/art.42645] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The goals of this study were to assess the associations of severe nonadherence to hydroxychloroquine (HCQ), objectively assessed by HCQ serum levels, and risks of systemic lupus erythematosus (SLE) flares, damage, and mortality rates over five years of follow-up. METHODS The Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort is an international multicenter initiative (33 centers throughout 11 countries). The serum of patients prescribed HCQ for at least three months at enrollment were analyzed. Severe nonadherence was defined by a serum HCQ level <106 ng/mL or <53 ng/mL for HCQ doses of 400 or 200 mg/day, respectively. Associations with the risk of a flare (defined as a Systemic Lupus Erythematosus Disease Activity Index 2000 increase ≥4 points, initiation of prednisone or immunosuppressive drugs, or new renal involvement) were studied with logistic regression, and associations with damage (first SLICC/American College of Rheumatology Damage Index [SDI] increase ≥1 point) and mortality with separate Cox proportional hazard models. RESULTS Of the 1,849 cohort participants, 660 patients (88% women) were included. Median (interquartile range) serum HCQ was 388 ng/mL (244-566); 48 patients (7.3%) had severe HCQ nonadherence. No covariates were clearly associated with severe nonadherence, which was, however, independently associated with both flare (odds ratio 3.38; 95% confidence interval [CI] 1.80-6.42) and an increase in the SDI within each of the first three years (hazard ratio [HR] 1.92 at three years; 95% CI 1.05-3.50). Eleven patients died within five years, including 3 with severe nonadherence (crude HR 5.41; 95% CI 1.43-20.39). CONCLUSION Severe nonadherence was independently associated with the risks of an SLE flare in the following year, early damage, and five-year mortality.
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Affiliation(s)
- Yann Nguyen
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP‐HP Centre and Université Paris Cité and Centre de Recherche en Epidémiologie et Statistiques (CRESS), Unité Inserm 1153, Université de Paris CitéParisFrance
| | - Benoît Blanchet
- Biologie du médicament‐Toxicologie, AP‐HP Centre–Hôpital Cochin, Université Paris Cité, and UMR8038 CNRS, U1268 INSERM, Université Paris Cité, PRES Sorbonne Paris Cité, CARPEMParisFrance
| | | | - John G. Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie UniversityHalifaxNova ScotiaCanada
| | - Caroline Gordon
- Institute of Inflammation and Ageing, University of BirminghamBirminghamUnited Kingdom
| | - Sang‐Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology, and Hanyang University Institute of Bioscience and BiotechnologySeoulKorea
| | | | | | - Ann E. Clarke
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | | | | | | | | | | | | | - Dafna D. Gladman
- Toronto Western Hospital, University of TorontoTorontoOntarioCanada
| | - Ian N. Bruce
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center and Centre for Epidemiology Versus Arthritis, The University of ManchesterManchesterUK
| | - Michelle Petri
- Johns Hopkins University School of MedicineBaltimoreMaryland
| | | | - Mary Anne Dooley
- Thurston Arthritis Research Center, University of North CarolinaChapel Hill
| | | | - Susan Manzi
- Allegheny Health NetworkPittsburghPennsylvania
| | | | | | | | - Cynthia Aranow
- Feinstein Institute for Medical ResearchManhassetNew York
| | - Véronique Le Guern
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP‐HP Centre, Université Paris CitéParisFrance
| | - Meggan Mackay
- Feinstein Institute for Medical ResearchManhassetNew York
| | | | - S. Sam Lim
- Emory University School of MedicineAtlantaGeorgia
| | | | | | - Søren Jacobsen
- Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | | | | | - Anca Askanase
- Hospital for Joint Diseases and, Seligman Centre for Advanced Therapeutics, New York UniversityNew York City
| | - Jill Buyon
- New York University School of MedicineNew York City
| | - Nathalie Costedoat‐Chalumeau
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP‐HP Centre and Université Paris Cité and Centre de Recherche en Epidémiologie et Statistiques (CRESS), Unité Inserm 1153, Université de Paris CitéParisFrance
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Londe AC, Fernandez-Ruiz R, Julio PR, Appenzeller S, Niewold TB. Type I Interferons in Autoimmunity: Implications in Clinical Phenotypes and Treatment Response. J Rheumatol 2023; 50:1103-1113. [PMID: 37399470 DOI: 10.3899/jrheum.2022-0827] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 07/05/2023]
Abstract
Type I interferon (IFN-I) is thought to play a role in many systemic autoimmune diseases. IFN-I pathway activation is associated with pathogenic features, including the presence of autoantibodies and clinical phenotypes such as more severe disease with increased disease activity and damage. We will review the role and potential drivers of IFN-I dysregulation in 5 prototypic autoimmune diseases: systemic lupus erythematosus, dermatomyositis, rheumatoid arthritis, primary Sjögren syndrome, and systemic sclerosis. We will also discuss current therapeutic strategies that directly or indirectly target the IFN-I system.
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Affiliation(s)
- Ana Carolina Londe
- A.C. Londe, MSc, Autoimmunity Lab, and Graduate Program in Physiopathology, School of Medical Science, State University of Campinas, Campinas, São Paulo, Brazil
| | - Ruth Fernandez-Ruiz
- R. Fernandez-Ruiz, MD, Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Paulo Rogério Julio
- P. Rogério Julio, MSc, Autoimmunity Lab, and Graduate Program of Child and Adolescent Health, School of Medical Science, State University of Campinas, Campinas, São Paulo, Brazil
| | - Simone Appenzeller
- S. Appenzeller, MD, PhD, Autoimmunity Lab, and Rheumatology Unit, Department of Medicine, School of Medical Science, State University of Campinas, Campinas, São Paulo, Brazil
| | - Timothy B Niewold
- T.B. Niewold, MD, Department of Medicine, Hospital for Special Surgery, New York, New York, USA.
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Gan T, Qu S, Zhang H, Zhou X. Modulation of the immunity and inflammation by autophagy. MedComm (Beijing) 2023; 4:e311. [PMID: 37405276 PMCID: PMC10315166 DOI: 10.1002/mco2.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/12/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Autophagy, a highly conserved cellular self-degradation pathway, has emerged with novel roles in the realms of immunity and inflammation. Genome-wide association studies have unveiled a correlation between genetic variations in autophagy-related genes and heightened susceptibility to autoimmune and inflammatory diseases. Subsequently, substantial progress has been made in unraveling the intricate involvement of autophagy in immunity and inflammation through functional studies. The autophagy pathway plays a crucial role in both innate and adaptive immunity, encompassing various key functions such as pathogen clearance, antigen processing and presentation, cytokine production, and lymphocyte differentiation and survival. Recent research has identified novel approaches in which the autophagy pathway and its associated proteins modulate the immune response, including noncanonical autophagy. This review provides an overview of the latest advancements in understanding the regulation of immunity and inflammation through autophagy. It summarizes the genetic associations between variants in autophagy-related genes and a range of autoimmune and inflammatory diseases, while also examining studies utilizing transgenic animal models to uncover the in vivo functions of autophagy. Furthermore, the review delves into the mechanisms by which autophagy dysregulation contributes to the development of three common autoimmune and inflammatory diseases and highlights the potential for autophagy-targeted therapies.
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Affiliation(s)
- Ting Gan
- Renal DivisionPeking University First HospitalBeijingChina
- Peking University Institute of NephrologyBeijingChina
- Key Laboratory of Renal DiseaseMinistry of Health of ChinaBeijingChina
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University)Ministry of EducationBeijingChina
| | - Shu Qu
- Renal DivisionPeking University First HospitalBeijingChina
- Peking University Institute of NephrologyBeijingChina
- Key Laboratory of Renal DiseaseMinistry of Health of ChinaBeijingChina
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University)Ministry of EducationBeijingChina
| | - Hong Zhang
- Renal DivisionPeking University First HospitalBeijingChina
- Peking University Institute of NephrologyBeijingChina
- Key Laboratory of Renal DiseaseMinistry of Health of ChinaBeijingChina
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University)Ministry of EducationBeijingChina
| | - Xu‐jie Zhou
- Renal DivisionPeking University First HospitalBeijingChina
- Peking University Institute of NephrologyBeijingChina
- Key Laboratory of Renal DiseaseMinistry of Health of ChinaBeijingChina
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University)Ministry of EducationBeijingChina
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16
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Gajić M, Schröder-Heurich B, Horvat Mercnik M, Cervar-Zivkovic M, Wadsack C, von Versen-Höynck F, Mayer-Pickel K. The Impact of Hydroxychloroquine on Primary Feto-Placental Endothelial Cells from Healthy and Early-Onset Preeclamptic Placentas. Int J Mol Sci 2023; 24:10934. [PMID: 37446111 PMCID: PMC10341411 DOI: 10.3390/ijms241310934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Hydroxychloroquine (HCQ), an anti-malarial drug, is suggested as a promising candidate for the treatment of pregnancy-related disorders associated with endothelial activation, among which there is preeclampsia (PE). Arterial feto-placental endothelial cells (fpECAs) were isolated from control (CTR) and early-onset preeclamptic (EO-PE) placentas. The aim of this study was to test potential protective effects of HCQ in an in vitro model of endothelial activation as well as in cells isolated from EO-PE placentas. To mimic PE conditions, CTR fpECAs were exposed to a pro-inflammatory environment consisting of tumor necrosis factor α (TNF-α), interleukin (IL)-6 and IL-1β (furtherly referred as MIX) with or without varying concentrations of HCQ (1 µg/mL and 10 µg/mL). Their effect on wound healing and endothelial barrier integrity was analyzed. Variations in the expression of IL-8 and leukocyte adhesion molecules (LAM) on both mRNA and protein levels were determined between CTR and PE fpECAs in the presence or absence of HCQ. MIX decreased wound healing and stability of the endothelial barrier, but HCQ did not affect it. Significant differences between CTR and EO-PE fpECAs were observed in IL-8 mRNA, protein secretion, and vascular cell adhesion protein 1 (VCAM-1) mRNA expression levels. After challenging CTR fpECAs with MIX, upregulation of both mRNA and protein levels was observed in all molecules. Combined treatment of HCQ and MIX slightly lowered VCAM-1 total protein amount. In CTR fpECAs, treatment with low concentrations of HCQ alone (1 µg/mL) reduced basal levels of IL-8 and VCAM-1 mRNA and secretion of IL-8, while in EO-PE fpECAs, a higher (10µg/mL) HCQ concentration slightly reduced the gene expression of IL-8. Conclusion: These results provide additional support for the safety of HCQ, as it did not adversely affect endothelial functionality in control fpECAs at the tested concentration. Furthermore, the observed limited effects on IL-8 secretion in EO-PE fpECAs warrant further investigation, highlighting the need for clinical trials to assess the potential therapeutic effects of HCQ in preeclampsia. Conducting clinical trials would offer a more comprehensive understanding of HCQ's efficacy and safety, allowing us to explore its potential benefits and limitations in a real-world clinical setting.
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Affiliation(s)
- Maja Gajić
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A-8036 Graz, Austria; (M.G.); (M.H.M.); (M.C.-Z.); (C.W.)
| | - Bianca Schröder-Heurich
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (B.S.-H.); (F.v.V.-H.)
| | - Monika Horvat Mercnik
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A-8036 Graz, Austria; (M.G.); (M.H.M.); (M.C.-Z.); (C.W.)
| | - Mila Cervar-Zivkovic
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A-8036 Graz, Austria; (M.G.); (M.H.M.); (M.C.-Z.); (C.W.)
| | - Christian Wadsack
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A-8036 Graz, Austria; (M.G.); (M.H.M.); (M.C.-Z.); (C.W.)
- BioTechMed-Graz, Mozartgasse 12/II, A-8010 Graz, Austria
| | - Frauke von Versen-Höynck
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (B.S.-H.); (F.v.V.-H.)
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany
| | - Karoline Mayer-Pickel
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A-8036 Graz, Austria; (M.G.); (M.H.M.); (M.C.-Z.); (C.W.)
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Katarzyna PB, Wiktor S, Ewa D, Piotr L. Current treatment of systemic lupus erythematosus: a clinician's perspective. Rheumatol Int 2023:10.1007/s00296-023-05306-5. [PMID: 37171669 DOI: 10.1007/s00296-023-05306-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/04/2023] [Indexed: 05/13/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Its variable course makes it difficult to standardize patient treatment. This article aims at a literature review on available drugs for treating SLE and on drugs that have shown therapeutic effects in this disease. The PubMed/MEDLINE electronic search engine was used to identify relevant studies. This review presents the current therapeutic options, new biological therapies, and combination therapies of biologics with standard immunosuppressive and immunomodulating drugs. We have also underlined the importance to implement the treat-to-target strategy aimed at reducing or discontinuing therapy with glucocorticosteroids (GCs). The awareness of the benefits and risks of using GCs helps in refining their dosage and thereby obtaining a better safety profile. The advent of biological targeted therapies, and more recently, low-molecular-weight compounds such as kinase inhibitors, initiated numerous clinical trials in SLE patients and led to the approval of two biological drugs, belimumab, and anifrolumab, for SLE treatment. Progress in the treatment of SLE was reflected in the 2019 and 2021 recommendations of the European Alliance of Associations for Rheumatology (EULAR). However, a mass of recent clinical research data requires continuous consolidation to optimize patient outcomes.
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Affiliation(s)
- Pawlak-Buś Katarzyna
- Department of Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland.
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Struś Municipal Hospital, Poznań, Poland.
| | - Schmidt Wiktor
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Struś Municipal Hospital, Poznań, Poland
- Doctoral School, Poznań University of Medical Sciences, Poznań, Poland
| | - Dudziec Ewa
- Department of Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland
| | - Leszczyński Piotr
- Department of Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Struś Municipal Hospital, Poznań, Poland
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Zhong X, Jin YB, Zhang Q, Liu SL, He J. Low estimated glomerular filtration rate is an independent risk factor for higher hydroxychloroquine concentration. Clin Rheumatol 2023:10.1007/s10067-023-06576-x. [PMID: 36939974 DOI: 10.1007/s10067-023-06576-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND The aim of this study was to analyze the relationship of the estimated glomerular filtration rate (eGFR) to hydroxychloroquine (HCQ) blood concentrations in systemic lupus erythematosus (SLE) patients. METHOD Patients with SLE who had been taking HCQ for more than 12 months were recruited. All subjects gave written informed consent. Various clinical characteristics and laboratory values were examined. The blood concentration of HCQ was measured by high-performance liquid chromatography, and the relationship of eGFR to HCQ blood concentration was mainly investigated. RESULT In total, 115 patients with SLE receiving long-term HCQ therapy were included in the study. The median concentration of HCQ was 1096 ng/ml (range 116-8240 ng/ml). The eGFR was strongly associated with blood concentration of HCQ (P = 0.011, P < 0.05), when adjusted for age, sex, body mass index (BMI), weight-adjusted dose, prednisone use and immunosuppressive drug use. No statistically significant association were found between age, duration, BMI, weight-adjusted HCQ dose, corticosteroid use, immunosuppressant use and blood concentrations of HCQ. CONCLUSION We provided novel evidence that impaired renal function influenced the blood concentration of HCQ. Patients with low eGFR need to adjust the HCQ dosage according to the monitoring results of HCQ blood concentrations.
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Affiliation(s)
- Xue Zhong
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Yue-Bo Jin
- Department of Rheumatology & Immunology, Peking University People's Hospital, No. 11 South Avenue, Xi Zhi Men, Xicheng District, Beijing, China
| | - Qin Zhang
- Ophthalmology Optometry Centre, Peking University People's Hospital, Beijing, China
- Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Si-Lu Liu
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Jing He
- Department of Rheumatology & Immunology, Peking University People's Hospital, No. 11 South Avenue, Xi Zhi Men, Xicheng District, Beijing, China.
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CHOROIDAL VASCULARITY INDEX IN HYDROXYCHLOROQUINE TOXIC RETINOPATHY: A Quantitative Comparative Analysis Using Enhanced Depth Imaging In Spectral Domain Optical Coherence Tomography. Retina 2023; 43:94-101. [PMID: 36201756 DOI: 10.1097/iae.0000000000003638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/24/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate choroidal involvement in eyes of patients treated with hydroxychloroquine (HCQ), by quantifying the choroidal vascularity index (CVI) and other choroidal biomarkers. METHODS Vertical enhanced depth imaging spectral domain optical coherence tomography (SD-OCT) scans were performed in eyes with either advanced-stage or mild HCQ toxic retinopathy, as well as in healthy age-matched and sex-matched controls. Based on SD-OCT scans, the subfoveal and mean choroidal thickness (ChT) was measured. The CVI, total choroidal area (TCA), luminal choroidal area (LCA), and stromal choroidal area (SCA) were calculated based on a binarization image process. These variables were computed and compared between the three groups (i.e., advanced stage, mild toxicity, and healthy controls). RESULTS Forty-eight eyes of 47 patients under HCQ (26 eyes presented with advanced stage HCQ toxicity and 22 eyes with mild toxicity) and 34 eyes of 31 healthy controls were included. Both CVI and ChT were significantly different between the three groups ( P < 0.001, P < 0.001). When comparing the advanced stage toxicity group to healthy controls, both the subfoveal and the mean ChT were diminished ( P < 0.001). The CVI, TCA, LCA, and SCA were significantly lower in the advanced stage of toxicity group when compared with controls ( P < 0.001, <0.00001, <0.0001, and P = 0.0094, respectively). CONCLUSION Our study suggests that eyes with HCQ toxic retinopathy, especially at advanced stages, present with choroidal impairment, giving further pathophysiological insights into the unfolding of this retinal toxicity.
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Harsini S, Rezaei N. Autoimmune diseases. Clin Immunol 2023. [DOI: 10.1016/b978-0-12-818006-8.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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David C, Costedoat-Chalumeau N, Belhadi D, Laouénan C, Boutten A, Chezel J, Rouzaud D, Dehoux M, Guern VL, Mathian A, Chaves SDA, Duhaut P, Fain O, Galicier L, Ghillani-Dalbin P, Kahn JE, Morel N, Perard L, Pha M, Sarrot-Reynauld F, Aumaitre O, Chasset F, Limal N, Desmurs-Clavel H, Ackermann F, Amoura Z, Papo T, Sacre K. Soluble CD163 and incident cardiovascular events in patients with systemic lupus erythematosus: An observational cohort study. J Intern Med 2022; 292:536-539. [PMID: 35373869 PMCID: PMC9542031 DOI: 10.1111/joim.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Clémence David
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Nathalie Costedoat-Chalumeau
- APHP, Hôpital Cochin, Département de Médecine Interne, Centre de Reference Maladies Auto-immunes et Systémiques Rares, Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Drifa Belhadi
- Departement d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, APHP, Université de Paris, Paris, France
| | - Cedric Laouénan
- Departement d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, APHP, Université de Paris, Paris, France
| | - Anne Boutten
- Département de Biochimie, Hôpital Bichat, APHP, Université de Paris, Paris, France
| | - Julie Chezel
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Diane Rouzaud
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Monique Dehoux
- Département de Biochimie, Hôpital Bichat, APHP, Université de Paris, Paris, France
| | - Véronique Le Guern
- APHP, Hôpital Cochin, Département de Médecine Interne, Centre de Reference Maladies Auto-immunes et Systémiques Rares, Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Alexis Mathian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Paris, France
| | - Sébastien de Almeida Chaves
- Département de Médecine Interne, Hôpital Purpan, Centre Hospitalo-Universitaire (CHU) de Toulouse, Toulouse, France
| | - Pierre Duhaut
- Département de Médecine Interne, Hôpital Amiens Nord CHU d'Amiens, Amiens, France
| | - Olivier Fain
- Département de Médecine Interne, Hôpital Saint Antoine, APHP, Université Pierre et Marie Curie, Paris, France
| | - Lionel Galicier
- Département d'Immunologie Clinique, Hôpital Saint Louis, APHP, Université de Paris, Département de Médecine Interne, Hôpital Saint Joseph, Marseille, France
| | - Pascale Ghillani-Dalbin
- Département de Immunologie, Hôpital Pitié-Salpétrière, APHP, Université Pierre et Marie Curie, Paris, France
| | - Jean Emmanuel Kahn
- Département de Médecine Interne, Hôpital Ambroise Paré, APHP, Université de Versailles-Saint-Quentin en Yvelines, France
| | - Nathalie Morel
- APHP, Hôpital Cochin, Département de Médecine Interne, Centre de Reference Maladies Auto-immunes et Systémiques Rares, Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Laurent Perard
- Département de Médecine Interne, Hôpital St Joseph St Luc, Lyon, France
| | - Micheline Pha
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Paris, France
| | | | - Olivier Aumaitre
- Département de médecine interne, Hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, France
| | - François Chasset
- Département de médecine interne, Hôpital Tenon, APHP Université Pierre et Marie Curie, Paris, France
| | - Nicolas Limal
- Département de médecine interne, Hôpital Henri Mondor, APHP Université Paris-Est Créteil, Paris, France
| | - Helene Desmurs-Clavel
- Département de médecine interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Felix Ackermann
- Département de médecine interne, Hôpital Foch, Suresnes, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
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Halouani S, Le HM, Cohen SY, Terkmane N, Herda N, Souied EH, Miere A. Choriocapillaris Flow Deficits Quantification in Hydroxychloroquine Retinopathy Using Swept-Source Optical Coherence Tomography Angiography. J Pers Med 2022; 12:jpm12091445. [PMID: 36143230 PMCID: PMC9503306 DOI: 10.3390/jpm12091445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to quantitatively analyze choriocapillaris (CC) alterations using swept-source optical coherence tomography angiography (SS-OCTA) in eyes presenting with hydroxychloroquine (HCQ) toxic retinopathy and to compare it to patients under HCQ without toxic retinopathy and to healthy controls. For image analysis, CC en-face slabs were extracted from macular 6 × 6 mm SS-OCTA scans and a compensation method followed by the Phansalkar local thresholding was performed. Percentage of flow deficits (FD%) and other related biomarkers were computed for comparison. Fourteen eyes (7 patients) presenting with HCQ toxic retinopathy, sixty-two eyes (31 patients) under HCQ without signs of toxicity, and sixty eyes of 34 healthy controls were included. With regards to FD%, FD average size, and FD number there was a significant difference between the three groups (p < 0.05 with radius 4 and radius 8 pixels). Eyes presenting with HCQ toxicity had significantly higher FD% and average size, and a significantly lower number of FDs, with both radius 4 and 8 pixels. In conclusion, FD quantification demonstrates that CC involvement is present in HCQ toxic retinopathy, therefore giving pathophysiological insights with regards to the CC as being either the primary or secondary target of HCQ toxicity.
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Affiliation(s)
- Safa Halouani
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Avenue de Verdun, 94100 Créteil, France
| | - Hoang Mai Le
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Avenue de Verdun, 94100 Créteil, France
| | - Salomon Yves Cohen
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Avenue de Verdun, 94100 Créteil, France
| | - Narimane Terkmane
- Department of Ophthalmology, Hôpital Henri-Mondor AP-HP, 94100 Créteil, France
| | - Nabil Herda
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Avenue de Verdun, 94100 Créteil, France
| | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Avenue de Verdun, 94100 Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Avenue de Verdun, 94100 Créteil, France
- Correspondence:
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23
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Yeh JJ, Syue SH, Sun YF, Yeh YT, Zheng YC, Lin CL, Hsu CY, Kao CH. Hydroxychloroquine on the Pulmonary Vascular Diseases in Interstitial Lung Disease: Immunologic Effects, and Virus Interplay. Biomedicines 2022; 10:biomedicines10061290. [PMID: 35740313 PMCID: PMC9219797 DOI: 10.3390/biomedicines10061290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/05/2023] Open
Abstract
To investigate the effects of hydroxychloroquine (HCQ) drug use on the risk of pulmonary vascular disease (PVD) in an interstitial lung disease cohort (ILD cohort, ILD+ virus infection), we retrospectively enrolled the ILD cohort with HCQ (HCQ users, N = 4703) and the ILD cohort without HCQ (non-HCQ users, N = 4703) by time-dependence after propensity score matching. Cox models were used to analyze the risk of PVD. We calculated the adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs) for PVD after adjusting for sex, age, comorbidities, index date and immunosuppressants, such as steroids, etc. Compared with the HCQ nonusers, in HCQ users, the aHRs (95% CIs) for PVD were (2.24 (1.42, 3.54)), and the women’s aHRs for PVD were (2.54, (1.49, 4.35)). The aHRs based on the days of HCQ use for PVD of 28−30 days, 31−120 days, and >120 days were (1.27 (0.81, 1.99)), (3.00 (1.81, 4.87)) and (3.83 (2.46, 5.97)), respectively. The medium or long-term use of HCQ or young women receiving HCQ were associated with a higher aHR for PVD in the ILD cohort. These findings indicated interplay of the primary immunologic effect of ILD, comorbidities, women, age and virus in the HCQ users.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Family Medicine, Geriatric Medicine, Chest Medicine and Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan;
- College of Medicine, China Medical University, Taichung 406040, Taiwan; (C.-L.L.); (C.Y.H.)
| | - Shih-Hueh Syue
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan; (S.-H.S.); (Y.-F.S.); (Y.-T.Y.); (Y.-C.Z.)
| | - Yi-Fun Sun
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan; (S.-H.S.); (Y.-F.S.); (Y.-T.Y.); (Y.-C.Z.)
| | - Yi-Ting Yeh
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan; (S.-H.S.); (Y.-F.S.); (Y.-T.Y.); (Y.-C.Z.)
| | - Ya-Chi Zheng
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600566, Taiwan; (S.-H.S.); (Y.-F.S.); (Y.-T.Y.); (Y.-C.Z.)
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung 406040, Taiwan; (C.-L.L.); (C.Y.H.)
- Management Office for Health Data, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan
| | - Chung Y. Hsu
- College of Medicine, China Medical University, Taichung 406040, Taiwan; (C.-L.L.); (C.Y.H.)
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 406040, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, China Medical University, Taichung 406040, Taiwan
- Correspondence: or ; Tel.: +886-4-22052121
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Sun F, Zhao L, Wang H, Zhang D, Chen J, Wang X, Li T, Ye S. Risk factors of disease flares in a Chinese lupus cohort with low-grade disease activity. Lupus Sci Med 2022; 9:e000657. [PMID: 35606018 PMCID: PMC9125751 DOI: 10.1136/lupus-2022-000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Recurrent disease flare is one of the key problems in lupus patients. A Chinese Flare-Prevention Lupus Initiative Cohort (FLIC) was established. Risk factors of disease flare were evaluated accordingly. METHODS Patients with low-grade disease activity (the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI) =≤6, daily prednisone ≤20 mg, no British Isles Lupus Assessment Group A or no more than one B organ domain score) from January 2014 to August 2020 were included in the FLIC. Disease flares were defined by the modified SELENA--SLEDAI Flare Index. Low disease activity status (LDAS) and remission were also assessed. The cumulative flare rate was estimated by an event per 100 person-years analysis. Cox proportional hazards models were performed to identify risk factors of subsequent disease flares after adjusting clinical confounders. Survival was assessed with the Kaplan-Meier method. RESULTS 448 eligible patients with low-grade disease activity were included in FLIC. During a mean follow-up of 30.4 months, 170 patients flared. The cumulative lupus flare rate was 22.2 events per 100 patient-years. Compared with patients without flare, those with lupus flares were taking more prednisone, had higher disease activity index and with less patients attained LDAS/remission at baseline. They also had higher rates of antiphospholipid antibodies (aPLs) and antiribosomal P antibody. Cox regression analysis confirmed that attainment of either LDAS or remission at baseline were independent protective factors against subsequent disease flare (LDAS but not in remission: HR 0.58, 95% CI 0.38~0.88; remission: HR 0.46, 95% CI 0.30~0.69), while aPL was a risk factor of lupus flares (HR 1.95, 95% CI 1.36~2.78). Kaplan-Meier curves indicated that attaining LDAS or remission and absence of aPL at baseline had the least flare risk. CONCLUSIONS In our real-world cohort study, not attaining LDAS or remission at baseline and aPL positivity was associated with higher risk of disease flares in patients with low-grade SLE.
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Affiliation(s)
- Fangfang Sun
- Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Liling Zhao
- Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Haiting Wang
- Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Danting Zhang
- Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Jie Chen
- Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Xiaodong Wang
- Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Ting Li
- Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Shuang Ye
- Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
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25
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Djabarouti S, Mora P, Lahouati M, Gigan M, d’Houdain N, Sourisseau B, Chambord J, Xuereb F. Intérêt des dosages pharmacologiques d’immunosuppresseurs et immunomodulateurs dans la prise en charge des maladies autoimmunes. Rev Med Interne 2022; 43:412-418. [DOI: 10.1016/j.revmed.2022.03.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
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Abstract
PURPOSE OF REVIEW This review summarizes the recent literature exploring hydroxychloroquine levels and their relationship with disease activity and risk of toxicity. RECENT FINDINGS There is no clear correlation between weight-based dosing of hydroxychloroquine and the resulting blood levels of the medication. Recent studies have shown that increased hydroxychloroquine levels are associated with lower lupus disease activity and likely also increased risk of medication toxicity. SUMMARY Mounting evidence supports use of hydroxychloroquine levels in clinical practice to document adherence and ensure safety.
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Affiliation(s)
- Katherine Chakrabarti
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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David C, Duployez N, Eloy P, Belhadi D, Chezel J, Le Guern V, Laouénan C, Fenwarth L, Rouzaud D, Mathian A, de Almeida Chaves S, Duhaut P, Fain O, Galicier L, Ghillani-Dalbin P, Kahn JE, Morel N, Perard L, Pha M, Sarrot-Reynauld F, Aumaitre O, Chasset F, Limal N, Desmurs-Clavel H, Ackermann F, Amoura Z, Papo T, Preudhomme C, Costedoat-Chalumeau N, Sacre K. Clonal hematopoiesis of indeterminate potential and cardiovascular events in systemic lupus erythematosus (HEMATOPLUS study). Rheumatology (Oxford) 2022; 61:4355-4363. [PMID: 35176141 DOI: 10.1093/rheumatology/keac108] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The detection of somatic mutations in genes of myeloid cells in asymptomatic patients - defining clonal hematopoiesis of indeterminate potential (CHIP) - predisposes to cardiovascular events (CVE) in the general population. We aimed to determine whether CHIP was associated with CVE in SLE patients. METHODS The study is an ancillary study of the randomized, double-blind, placebo-controlled, multicenter trial PLUS study conducted from June 2007 through August 2010 at 37 centers in France involving 573 SLE patients. The search for somatic mutations by high-throughput sequencing of 53 genes involved in clonal hematopoiesis was performed on genomic DNA collected at PLUS inclusion. The CHIP prevalence was assessed in SLE and in a retrospective cohort of 479 patients free of hematological malignancy. The primary outcome was the incident CVE in SLE. RESULTS Screening for CHIP was performed in 438 SLE patients (38 [29-47] years, 91·8% female). Overall, 63 somatic mutations were identified in 47 patients defining a CHIP prevalence of 10·7% in SLE. Most SLE patients (78·7%) carried a single mutation. Most variants (62·5%) were located in the DNMT3A gene. CHIP was associated with age, age at SLE diagnosis and a lower frequency of antiphospholipid antibodies. CHIP occurred more than 20-years earlier (p < 0·00001) in SLE than in controls. The detection of CHIP at inclusion was not associated with the occurrence of CVE during follow up (HR = 0·42 (0·06 - 3·21), p = 0·406). CONCLUSION The prevalence of CHIP is high in SLE with respect to age but was not associated with incident CVE. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT05146414.
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Affiliation(s)
- Clémence David
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Nicolas Duployez
- University of Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020-UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000 Lille, France
| | - Philippine Eloy
- Departement d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, APHP, Université de Paris, Paris, France
| | - Drifa Belhadi
- Departement d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, APHP, Université de Paris, Paris, France
| | - Julie Chezel
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Véronique Le Guern
- APHP, Hôpital Cochin, Département de Médecine Interne, Centre de Reference Maladies Auto-immunes et Systémiques Rares, Paris, France; Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Cédric Laouénan
- Departement d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, APHP, Université de Paris, Paris, France
| | - Laurène Fenwarth
- University of Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020-UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000 Lille, France
| | - Diane Rouzaud
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Alexis Mathian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Paris, France
| | - Sébastien de Almeida Chaves
- Département de Médecine Interne, Hôpital Purpan, Centre Hospitalo-Universitaire (CHU) de Toulouse, Toulouse, France
| | - Pierre Duhaut
- Département de Médecine Interne, Hôpital Amiens Nord, CHU d'Amiens, Amiens, France
| | - Olivier Fain
- Département de Médecine Interne, Hôpital Saint Antoine, APHP, Université Pierre et Marie Curie, Paris, France
| | - Lionel Galicier
- Département d'Immunologie Clinique, Hôpital Saint Louis, APHP, Université de Paris, Paris, France; Département de Médecine Interne, Hôpital Saint Joseph, Marseille, France
| | - Pascale Ghillani-Dalbin
- Département de Immunologie, Hôpital Pitié-Salpétrière, APHP, Université Pierre et Marie Curie, Paris, France
| | - Jean Emmanuel Kahn
- Département de Médecine Interne, Hôpital Ambroise Paré, APHP, Université de Versailles-Saint-Quentin en Yvelines, France
| | - Nathalie Morel
- APHP, Hôpital Cochin, Département de Médecine Interne, Centre de Reference Maladies Auto-immunes et Systémiques Rares, Paris, France; Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Laurent Perard
- Département de Médecine Interne, Hôpital St Joseph St Luc, Lyon, France
| | - Micheline Pha
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Paris, France
| | | | - Olivier Aumaitre
- Département de médecine interne, Hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, France
| | - François Chasset
- Département de médecine interne, Hôpital Tenon, APHP Université Pierre et Marie Curie, Paris, France
| | - Nicolas Limal
- Département de médecine interne, Hôpital Henri Mondor, APHP Université Paris-Est Créteil, Paris, France
| | - Helene Desmurs-Clavel
- Département de médecine interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Felix Ackermann
- Département de médecine interne, Hôpital Foch, Suresnes, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Claude Preudhomme
- University of Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020-UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000 Lille, France
| | - Nathalie Costedoat-Chalumeau
- APHP, Hôpital Cochin, Département de Médecine Interne, Centre de Reference Maladies Auto-immunes et Systémiques Rares, Paris, France; Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
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Dima A, Jurcut C, Chasset F, Felten R, Arnaud L. Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge. Ther Adv Musculoskelet Dis 2022; 14:1759720X211073001. [PMID: 35186126 PMCID: PMC8848057 DOI: 10.1177/1759720x211073001] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/17/2021] [Indexed: 12/22/2022] Open
Abstract
The antimalarial hydroxychloroquine (HCQ) has demonstrated several crucial properties for the treatment of systemic lupus erythematosus (SLE). Herein, we reviewed the main HCQ pharmacologic features, detailed its mechanism of action, and summarized the existing guidelines and recommendations for HCQ use in rheumatology with a systematic literature search for the randomized controlled trials focused on lupus. HCQ has been shown to decrease SLE activity, especially in mild and moderate disease, to prevent disease flare and to lower the long-term glucocorticoid need. The numerous benefits of HCQ are extended to pregnancy and breastfeeding period. Based on cohort studies, antithrombotic and metabolic HCQ’s effects were shown, including lipid-lowering properties, which might contribute to an improved cardiovascular risk. Moreover, early HCQ use in antinuclear antibodies positive individuals might delay the progression to SLE. Finally, HCQ has a significant favorable impact on long-term outcomes such as damage accrual and mortality in SLE. Based on these multiple benefits, HCQ is now the mainstay long-term treatment in SLE, recommended by current guidelines in all patients unless contraindications or side effects. The daily dose associated with the best compromise between efficacy and safety is matter of debate. The concern regarding retinal toxicity rather than proper efficacy data is the one that dictated the daily dosage of ⩽5 mg/kg/day actual body weight currently agreed upon.
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Affiliation(s)
- Alina Dima
- Department of Rheumatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Ciprian Jurcut
- Department of Internal Medicine, Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - François Chasset
- Department of Dermatology and Allergology, Hôpital Tenon, Paris, France; Faculté de Médecine, Sorbonne Université, Paris, France
| | - Renaud Felten
- National Reference Center for Rare Auto-immune and Systemic Diseases Est Sud-Est (RESO), Strasbourg, France
- Department of Rheumatology, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- National Reference Center for Rare Auto-immune and Systemic Diseases Est Sud-Est (RESO), Strasbourg, France
- Department of Rheumatology, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Université de Strasbourg, Inserm UMR-S 1109, Strasbourg, France
- Service de Rhumatologie, Hôpital de Hautepierre, 1, avenue Molière BP 83049, 67098 Strasbourg Cedex, France
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Crow MK, Kirou KA. Hydroxychloroquine and lupus flare: a good drug, but we need to do better. Ann Rheum Dis 2022; 81:303-305. [PMID: 35039325 DOI: 10.1136/annrheumdis-2021-221590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Mary K Crow
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, New York, New York, USA
| | - Kyriakos A Kirou
- Department of Medicine, Hospital for Special Surgery, New York, New York, USA
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Gallagher KL, Patel P, Beresford MW, Smith EMD. What Have We Learnt About the Treatment of Juvenile-Onset Systemic Lupus Erythematous Since Development of the SHARE Recommendations 2012? Front Pediatr 2022; 10:884634. [PMID: 35498799 PMCID: PMC9047745 DOI: 10.3389/fped.2022.884634] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Juvenile-onset systemic lupus erythematous (JSLE) is a rare multisystem autoimmune disorder. In 2012, the Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) initiative developed recommendations for the diagnosis/management of JSLE, lupus nephritis (LN) and childhood-onset anti-phospholipid syndrome (APS). These recommendations were based upon available evidence informing international expert consensus meetings. Objective To review new evidence published since 2012 relating to the management of JSLE, LN and APS in children, since the original literature searches informing the SHARE recommendations were performed. Method MEDLINE, EMBASE and CINAHL were systematically searched for relevant literature (2012-2021) using the following criteria: (1) English language studies; (2) original research studies regarding management of JSLE, LN, APS in children; (3) adult studies with 3 or more patients <18-years old, or where the lower limit of age range ≤16-years and the mean/median age is ≤30-years; (4) randomized controlled trials (RCTs), cohort studies, case control studies, observational studies, case-series with >3 patients. Three reviewers independently screened all titles/abstracts against predefined inclusion/exclusion criteria. All relevant manuscripts were reviewed independently by at least two reviewers. Data extraction, assessment of the level of evidence/methodological quality of the manuscripts was undertaken in-line with the original SHARE processes. Specific PUBMED literature searches were also performed to identify new evidence relating to each existing SHARE treatment recommendation. Results Six publications met the inclusion/exclusion criteria for JSLE: three RCTs, one feasibility trial, one case series. For LN, 16 publications met the inclusion/exclusion criteria: eight randomized trials, three open label prospective clinical trials, five observational/cohort studies. For APS, no publications met the inclusion criteria. The study with the highest evidence was an RCT comparing belimumab vs. placebo, including 93 JSLE patients. Whilst the primary-endpoint was not met, a significantly higher proportion of belimumab-treated patients met the PRINTO/ACR cSLE response to therapy criteria. New evidence specifically addressing each SHARE recommendation remains limited. Conclusion Since the original SHARE literature searches, undertaken >10-years ago, the main advance in JSLE treatment evidence relates to belimumab. Additional studies are urgently needed to test new/existing agents, and assess their long-term safety profile in JSLE, to facilitate evidence-based practice.
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Affiliation(s)
- Kathy L Gallagher
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Pallavi Patel
- Department of Public Health, Liverpool City Council, Liverpool, United Kingdom
| | - Michael W Beresford
- Institute of Life Course and Medical Science, University of Liverpool, Liverpool, United Kingdom.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Eve Mary Dorothy Smith
- Institute of Life Course and Medical Science, University of Liverpool, Liverpool, United Kingdom.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
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Andrade Balbi V, Artur Silva C, Nascimento Pedrosa T, Maria Rodrigues Pereira R, Maria de Arruda Campos L, Pires Leon E, Duarte N, Melechco Carvalho V, Gofint Pasoto S, Cordeiro do Rosário D, Kolachinski Brandao L, I Brunner H, Bonfá E, Emi Aikawa N. Hydroxychloroquine blood levels predicts flare in childhood-onset lupus nephritis. Lupus 2021; 31:97-104. [PMID: 34965782 DOI: 10.1177/09612033211062515] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Low hydroxychloroquine (HCQ) blood levels are predictors of flare in adult lupus. Childhood-onset systemic lupus erythematosus (cSLE) has high morbidity with renal involvement in up to 80% of cases. The aim of this study is to determine the HCQ cut-off levels which predicts flare in childhood-onset lupus nephritis (LN). METHODS Sixty LN patients on HCQ use for at least 6-months were prospectively evaluated at baseline (BL) and about 6-months later for cSLE flare and HCQ blood levels (ng/mL) measured by liquid chromatography-tandem mass spectrometry. RESULTS There were 19 patients (32%) with flare, during the study with median SLEDAI increase of 4 (0-8). Median (IQR) BL HCQ levels of the flare group were lower compared to stable patients [557.5 (68.6-980.3) vs. 1061.9 (534.8-1590.0 ng/mL); p=0.012]. ROC curve analysis demonstrated that HCQ levels≤1075 ng/mL were associated with a 5.08 (95%CI 1.28-20.13; p=0.021) times increased risk of flare. Six-month HCQ levels revealed that most patients 24/54 (44%) had persistently low levels (≤1075) during follow-up. Among those, 11/24 (46%) had flare. Multiple logistic regression analysis including prednisone use, baseline SLEDAI-2K, adherence based on pharmacy refill and BL HCQ blood levels as possible predictors of flare revealed that only HCQ blood level was independently associated with flare (OR 0.999, 95%CI 0.998-1.0, p=0.013). CONCLUSIONS We demonstrated that HCQ blood cut-off level under 1075 ng/mL predicts flare in childhood-onset LN patients under prescribed HCQ dose of 4.0-5.5 mg/kg/day. We further observed that most of these patients have compliance issues reinforcing the need for a close surveillance particularly in those with levels below the defined cut-off.
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Affiliation(s)
- Verena Andrade Balbi
- Rheumatology Unit, Instituto da Criança da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Clovis Artur Silva
- Pediatria, Faculdade de Medicina da Universidade de São Paulo, Sao Paul, Brazil
| | - Tatiana Nascimento Pedrosa
- Rheumatology Unit, Instituto da Criança da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Elaine Pires Leon
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nilo Duarte
- Division of Central Laboratory, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Sandra Gofint Pasoto
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Debora Cordeiro do Rosário
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leticia Kolachinski Brandao
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Hermine I Brunner
- Peds Rheum, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eloisa Bonfá
- Division of Central Laboratory, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadia Emi Aikawa
- Rheumatology Unit, Instituto da Criança da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Targeting lysosomes in human disease: from basic research to clinical applications. Signal Transduct Target Ther 2021; 6:379. [PMID: 34744168 PMCID: PMC8572923 DOI: 10.1038/s41392-021-00778-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/26/2021] [Indexed: 01/18/2023] Open
Abstract
In recent years, accumulating evidence has elucidated the role of lysosomes in dynamically regulating cellular and organismal homeostasis. Lysosomal changes and dysfunction have been correlated with the development of numerous diseases. In this review, we interpreted the key biological functions of lysosomes in four areas: cellular metabolism, cell proliferation and differentiation, immunity, and cell death. More importantly, we actively sought to determine the characteristic changes and dysfunction of lysosomes in cells affected by these diseases, the causes of these changes and dysfunction, and their significance to the development and treatment of human disease. Furthermore, we outlined currently available targeting strategies: (1) targeting lysosomal acidification; (2) targeting lysosomal cathepsins; (3) targeting lysosomal membrane permeability and integrity; (4) targeting lysosomal calcium signaling; (5) targeting mTOR signaling; and (6) emerging potential targeting strategies. Moreover, we systematically summarized the corresponding drugs and their application in clinical trials. By integrating basic research with clinical findings, we discussed the current opportunities and challenges of targeting lysosomes in human disease.
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Ozturk K, Caglayan S, Tanatar A, Baglan E, Yener Otar G, Kavrul Kayaalp G, Karadag SG, Demir F, Sonmez HE, Ozdel S, Cakan M, Aktay Ayaz N, Sozeri B. Low disease activity state in juvenile-onset systemic lupus erythematosus. Lupus 2021; 30:2144-2150. [PMID: 34723709 DOI: 10.1177/09612033211054399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the rate of achieving The Lupus Low Disease Activity State (LLDAS) in children with systemic lupus erythematosus (SLE) for tracing pertinent treatment modalities. METHODS A total of 122 juvenile-onset SLE (jSLE) patients from six pediatric rheumatology centers in Turkey were enrolled in the study. LLDAS-50 was defined as encountering LLDAS for at least 50% of the observation time. According to the achievement of LLDAS-50, clinical features, immunological profiles, and treatments of patients with jSLE have been revealed. RESULTS LLDAS of any duration was achieved by 82% of the cohort. Although only 10.8% of the patients achieved remission, 68.9% reached LLDAS-50. A significant difference was found between patients who reached LLDAS-50 and those who did not, in terms of the time to reach low-dose corticosteroid treatment (p = 0.002), the presence of subacute cutaneous findings (p = 0.007), and the presence of proteinuria (p = 0.002). Both of the groups were under similar treatment approaches. However, the number of patients being treated with corticosteroids at the last visit was found to be significantly higher in patients who achieved LLDAS-50 (p<0.001). CONCLUSION Targeting LLDAS in jSLE, even with long-term, low-dose corticosteroid use, seems to be an achievable goal in clinical practice.
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Affiliation(s)
- Kubra Ozturk
- Department of Pediatric Rheumatology, Goztepe Prof. Dr Suleyman Yalcın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Senğul Caglayan
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Ayse Tanatar
- Department of Pediatric Rheumatology, 64041Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Esra Baglan
- Department of Pediatric Rheumatology, University of Health Sciences, 146993Dr Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Gulcin Yener Otar
- Department of Pediatric Rheumatology, Sanlıurfa Research and Training Hospital, Sanliurfa, Turkey
| | - Gulsah Kavrul Kayaalp
- Department of Pediatric Rheumatology, 64041Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Serife Gul Karadag
- Department of Pediatric Rheumatology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Hafize Emine Sonmez
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Semanur Ozdel
- Department of Pediatric Rheumatology, University of Health Sciences, 146993Dr Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Mustafa Cakan
- Department of Pediatric Rheumatology, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, 64041Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Betul Sozeri
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
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Brady K, Alexander RV, Stimson D, Rudolph M, Kammesheidt A. Capillary Blood Levels of Hydroxychloroquine and Methotrexate Are Stable for up to 5 Years When Collected on Volumetric Absorptive Microsamplers. J Appl Lab Med 2021; 6:858-867. [PMID: 33555010 DOI: 10.1093/jalm/jfaa221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hydroxychloroquine (HCQ) and methotrexate (MTX) are common antirheumatic drugs used chronically by patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) (1, 2). Therapeutic drug monitoring (TDM) of HCQ and MTX provides critical compliance information, but typically requires venipuncture and shipment of refrigerated blood samples to the clinical laboratory. Capillary blood collection by finger prick offers a convenient alternative to venipuncture. The long-term stability of capillary blood HCQ and MTX collected using volumetric absorptive microsamplers (VAMS) has not previously been evaluated. In this study, we evaluated the stability of capillary MTX and HCQ levels when stored on VAMS for up to 5 years. METHODS Samples of patients with RA and SLE were collected for HCQ or MTX monitoring as part of 2 clinical studies in 2015 (HCQ: n = 24 | MTX: n = 61) and 2017 (HCQ: n = 126). Venous and capillary blood samples were shipped to Exagen Inc.'s clinical laboratory. HCQ and MTXPG3 were measured using separate LC-MS/MS methodologies. Baseline venous blood levels of HCQ and MTXPG3 were determined within 1 week of draw and compared to capillary blood levels determined following 3 or 5 years of storage. RESULTS Venous blood HCQ and capillary blood MTXPG3 determinations made at baseline were significantly different from capillary blood determinations performed following 5 years of storage at -80 °C. However, these differences were within the specified limits of agreement [HCQ: Avg % change after storage (CI 95%) = -7.1% (-12.6, -1.6%), pt-test = 0.0205, interclass correlation coefficient (ICC) = 0.96 | MTXPG3: Avg % change after storage (CI 95%) = 13.3% (7.1, 19.4%), pt-test = 0.0001, ICC = 0.90]. CONCLUSION Dried capillary blood HCQ and MTXPG3 levels collected on VAMS are stable for up to 5 years.
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Affiliation(s)
- Kelley Brady
- Research and Development, Exagen Inc, 1261 Liberty Way, Suite C, Vista CA 92081
| | | | - Deborah Stimson
- Research and Development, Exagen Inc, 1261 Liberty Way, Suite C, Vista CA 92081
| | - Mark Rudolph
- Research and Development, Exagen Inc, 1261 Liberty Way, Suite C, Vista CA 92081
| | - Anja Kammesheidt
- Research and Development, Exagen Inc, 1261 Liberty Way, Suite C, Vista CA 92081
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Chezel J, Costedoat-Chalumeau N, Laouénan C, Rouzaud D, Chenevier-Gobeaux C, Le Guern V, Mathian A, Belhadi D, de Almeida Chaves S, Duhaut P, Fain O, Galicier L, Ghillani-Dalbin P, Kahn JE, Morel N, Perard L, Pha M, Saidoune F, Sarrot-Reynauld F, Aumaitre O, Chasset F, Limal N, Desmurs-Clavel H, Ackermann F, Amoura Z, Papo T, Sacre K. Highly sensitive serum cardiac troponin T and cardiovascular events in patients with systemic lupus erythematosus (TROPOPLUS study). Rheumatology (Oxford) 2021; 60:1210-1215. [PMID: 32901293 DOI: 10.1093/rheumatology/keaa434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/20/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Identification of biological markers able to better stratify cardiovascular risks in SLE patients is needed. We aimed to determine whether serum cardiac troponin T (cTnT) levels measured with a highly sensitive assay [high sensitivity cTnT (HS-cTnT)] may predict cardiovascular events (CVEs) in SLE. METHOD All SLE patients included between 2007 and 2010 in the randomized, double-blind, placebo-controlled, multicentre PLUS trial were screened. Patients with no past history of CVE at inclusion and a follow-up period of >20 months were analysed. HS-cTnT concentration was measured using the electrochemiluminescence method on serum collected at PLUS inclusion. The primary outcome was the incident CVE. Factors associated with the primary outcome were identified and multivariate analysis was performed. RESULTS Overall, 442 SLE patients (of the 573 included in the PLUS study) were analysed for the primary outcome with a median follow up of 110 (interquartile range: 99-120) months. Among them, 29 (6.6%) experienced at least one CVE that occurred at a median of 67 (interquartile range: 31-91) months after inclusion. Six out of 29 patients had more than one CVE. In the multivariate analysis, dyslipidaemia, age and HS-cTnT were associated with the occurrence of CVE. Kaplan-Meier analysis showed that a concentration of HS-cTnT > 4.27 ng/l at inclusion increased by 2.7 [hazard ratio 2.7 (95% CI: 1.3, 5.6), P =0.0083] the risk of CVE in SLE. CONCLUSION HS-cTnT measured in serum is the first identified biomarker independently associated with incident CVE in SLE patients.
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Affiliation(s)
- Julie Chezel
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, France
| | - Nathalie Costedoat-Chalumeau
- Département de Médecine Interne, Hôpital Cochin, Centre de Reference Maladies Auto-immunes et Systémiques Rares, APHP, Université de Paris, CRESS, INSERM, INRA, France
| | - Cedric Laouénan
- Departement d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, France
| | - Diane Rouzaud
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, France
| | - Camille Chenevier-Gobeaux
- Service de Diagnostic Biologique Automatisé, Département médico-universitaire BioPhyGen, Hôpital Cochin, APHP, Université de Paris, Paris, France
| | - Véronique Le Guern
- Département de Médecine Interne, Hôpital Cochin, Centre de Reference Maladies Auto-immunes et Systémiques Rares, APHP, Université de Paris, CRESS, INSERM, INRA, France
| | - Alexis Mathian
- Département de Médecine Interne 2, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Groupement Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Drifa Belhadi
- Departement d'Epidémiologie et de Recherche Clinique, Hôpital Bichat, France
| | - Sébastien de Almeida Chaves
- Département de Médecine Interne, Hôpital Purpan, Centre Hospitalo-Universitaire (CHU) de Toulouse, Toulouse, France
| | - Pierre Duhaut
- Département de Médecine Interne, Hôpital Amiens Nord, CHU d'Amiens, Amiens, France
| | - Olivier Fain
- Département de Médecine Interne, Hôpital Saint Antoine, APHP, Université Pierre et Marie Curie, Paris, France
| | - Lionel Galicier
- Département d'Immunologie Clinique, Hôpital Saint Louis, APHP, Université de Paris, Paris, France
| | - Pascale Ghillani-Dalbin
- Département de Immunologie, Hôpital Pitié-Salpétrière, APHP, Université Pierre et Marie Curie, Paris, France
| | - Jean Emmanuel Kahn
- Département de Médecine Interne, Hôpital Ambroise Paré, APHP, Université de Versailles-Saint-Quentin en Yvelines, Versailles, France
| | - Nathalie Morel
- Département de Médecine Interne, Hôpital Cochin, Centre de Reference Maladies Auto-immunes et Systémiques Rares, APHP, Université de Paris, CRESS, INSERM, INRA, France
| | - Laurent Perard
- Département de Médecine Interne, Hôpital St Joseph St Luc, Lyon, France
| | - Micheline Pha
- Département de Médecine Interne 2, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Groupement Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Fanny Saidoune
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, France
| | | | - Olivier Aumaitre
- Département de médecine interne, Hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - François Chasset
- Département de médecine interne, Hôpital Tenon, APHP Université Pierre et Marie Curie, Paris, France
| | - Nicolas Limal
- Département de médecine interne, Hôpital Henri Mondor, APHP Université Paris-Est Créteil, Paris, France
| | - Helene Desmurs-Clavel
- Département de médecine interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Felix Ackermann
- Département de médecine interne, Hôpital Foch, Suresnes, France
| | - Zahir Amoura
- Département de Médecine Interne 2, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Groupement Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, France
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Abdelbaky MSE, El Mamoun TA, Mabrouk FI, Hassan RM. Frequency and risk factors for hydroxychloroquine retinopathy among patients with systemic lupus erythematosus. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021; 33:18. [PMID: 34121836 PMCID: PMC8184260 DOI: 10.1186/s43162-021-00047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hydroxychloroquine (HCQ) is an antimalarial drug, recently used in COVID-19 treatment. Also it is considered over many years the cornerstone in treating systemic lupus erythematosus (SLE) in adults and children. The incidence of retinal affection and retinal toxicity from hydroxychloroquine is rare, but even after the HCQ is stopped, loss of vision may not be reversible and may continue to progress. Fundus autofluorescence (FAF) is one of the screening methods recommended by AAO used for the diagnosis of hydroxychloroquine retinopathy. Our aim is to detect early HCQ-induced retinopathy among SLE patients and the risk factors for its development by using fundus autofluorescence. Results In the present study, 11.3% of the studied patients had significant visual field changes upon testing. Of those, 6.3% had abnormal fundus autofluorescence. We found a significant statistical relation between hydroxychloroquine retinopathy and the duration and cumulative dose of hydroxychloroquine therapy (p value = 0.003) and decreased best-corrected visual acuity of both eyes (p value = 0.000). There was no relationship between HCQ retinopathy detected by fundus autofluorescence and daily dose of HCQ/kg, age, sex, and SLEDAI score. Conclusion Frequency of SLE patients who had confirmed HCQ-induced retinopathy was 6.3%. Hydroxychloroquine could be safely used in all SLE patients regardless of age, sex, and SLE activity. Routine ophthalmological assessment is recommended for SLE patients who received HCQ especially for those who received HCQ longer than 7 years. Fundus autofluorescence is a modern objective tool which is specific for the early detection of HCQ retinopathy.
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Affiliation(s)
| | | | | | - Rasha Mohamad Hassan
- Department of Medicine Division of Rheumatology, Ain Shams University, Cairo, Egypt
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Kao JH, Lan TY, Li KJ. More Steps Forward to Optimize the Dosing of Hydroxychloroquine: Comment on the Article by Petri et al. Arthritis Rheumatol 2021; 73:2149. [PMID: 34042311 DOI: 10.1002/art.41881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Jui-Hung Kao
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Ko-Jen Li
- National Taiwan University Hospital, Taipei, Taiwan
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Petitdemange A, Felten R, Sibilia J, Martin T, Arnaud L. Prescription strategy of antimalarials in cutaneous and systemic lupus erythematosus: an international survey. Ther Adv Musculoskelet Dis 2021; 13:1759720X211002595. [PMID: 34046091 PMCID: PMC8138289 DOI: 10.1177/1759720x211002595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Antimalarial agents (AMs), mainly hydroxychloroquine (HCQ) and chloroquine,
are the cornerstone of treatment of cutaneous and systemic lupus
erythematosus. However, many aspects of AM prescription remain empirical.
The aim of this study was to assess the modalities of AM prescription among
physicians treating patients with lupus and to verify the assumption that AM
use is heterogeneous and frequently at variance with international
guidelines. Methods: We performed an international cross-sectional study among physicians involved
in lupus care, using a web-based survey (from September 2019 to July 2020)
addressing the main controversial aspects of AM prescription. Results: A total of 298 physicians [median age: 42 (interquartile range: 17) years,
mainly internists and rheumatologists] from 35 countries participated to the
study. A total of 93% used HCQ as the first-line AM, 69.5% used fixed doses
of AMs (mainly 400 mg/day for HCQ) and only 37.9% adjusted the dose in case
of renal failure. The main reasons for measuring HCQ blood levels were
suspected non-adherence (55.7%) and failure of AM treatment (34.1%). In case
of AM failure, 58.0% added an immunosuppressive agent. In case of remission,
49.7% maintained the same dose of AM, whereas 48.3% reduced the dose.
One-third of respondents reported not following the American screening
guidelines on AM retinal toxicity and 40.9% started retinal screening from
the first year of treatment. Conclusion: This study highlights the strong heterogeneity of AM prescription in lupus,
as well as several key unmet needs regarding AMs. This may be improved by
developing more comprehensive recommendations and favoring dissemination
among physicians.
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Affiliation(s)
- Arthur Petitdemange
- Service de Rhumatologie, Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Renaud Felten
- Service de Rhumatologie, Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean Sibilia
- Service de Rhumatologie, Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thierry Martin
- Service d'Immunologie Clinique et de Médecine Interne, Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- Service de Rhumatologie, Centre National de Référence des Maladies Autoimmunes et Systémiques Rares (RESO), Hôpital de Hautepierre, 1 Avenue Molière BP 83049, Strasbourg Cedex, 67098, France
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Brilland B, Bach-Bunner M, Gomes CN, Larochette V, Foucher E, Plaisance M, Saulnier P, Costedoat-Chalumeau N, Ghillani P, Belizna C, Delneste Y, Augusto JF, Jeannin P. Serum Interleukin-26 Is a New Biomarker for Disease Activity Assessment in Systemic Lupus Erythematosus. Front Immunol 2021; 12:663192. [PMID: 34054830 PMCID: PMC8160525 DOI: 10.3389/fimmu.2021.663192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Interleukin-26 (IL-26) has a unique ability to activate innate immune cells due to its binding to circulating double-stranded DNA. High levels of IL-26 have been reported in patients with chronic inflammation. We aimed to investigate IL-26 levels in patients with systemic lupus erythematosus (SLE). Methods IL-26 serum levels were quantified by ELISA for 47 healthy controls and 109 SLE patients previously enrolled in the PLUS study. Performance of IL-26 levels and classical markers (autoantibodies or complement consumption) to identify an active SLE disease (SLE disease activity index (SLEDAI) score > 4) were compared. Results IL-26 levels were significantly higher in SLE patients than in controls (4.04 ± 11.66 and 0.74 ± 2.02 ng/mL; p = 0.005). IL-26 levels were also significantly higher in patients with active disease than those with inactive disease (33.08 ± 21.06 vs 1.10 ± 3.80 ng/mL, p < 0.0001). IL-26 levels correlated with SLEDAI score and the urine protein to creatinine ratio (uPCR) (p < 0.001). Patients with high IL-26 levels had higher SLEDAI score, anti-DNA antibodies levels, and uPCR (p < 0.05). They presented more frequently with C3 or C4 complement consumption. Lastly, IL-26 showed stronger performance than classical markers (complement consumption or autoantibodies) for active disease identification. Conclusions Our results suggest that, in addition to classical SLE serological markers, the measurement of IL-26 levels may be a useful biomarker for active disease identification in SLE patients.
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Affiliation(s)
- Benoit Brilland
- CHU Angers, Service de Néphrologie-Dialyse-Transplantation, Angers, France.,Univ Angers, CHU Angers, INSERM, CRCINA, Angers, France
| | | | | | | | | | - Marc Plaisance
- Service de Pharmacologie et d'Immunoanalyse, Commissariat à l'Energie Atomique Saclay, iBiTec-S, Gif sur Yvette, France
| | - Patrick Saulnier
- Univ Angers, INSERM, CNRS, MINT, Angers, France.,CHU Angers, Département de Bio-Statistiques et de Méthodologie, Angers, France
| | - Nathalie Costedoat-Chalumeau
- Internal Medicine Department, Referral Center for Rare Autoimmune and Systemic Diseases, Hospital Cochin, Paris, France
| | - Pascale Ghillani
- Internal Medicine Department, Referral Center for Rare Autoimmune and Systemic Diseases, Hospital Cochin, Paris, France
| | - Cristina Belizna
- CHU Angers, Service de Médecine interne, Angers, France.,Univ Angers, INSERM, CNRS, MitoVasc, Angers, France
| | - Yves Delneste
- Univ Angers, CHU Angers, INSERM, CRCINA, Angers, France.,CHU Angers, Service d'Immunologie et Allergologie, Angers, France
| | - Jean-François Augusto
- CHU Angers, Service de Néphrologie-Dialyse-Transplantation, Angers, France.,Univ Angers, CHU Angers, INSERM, CRCINA, Angers, France
| | - Pascale Jeannin
- Univ Angers, CHU Angers, INSERM, CRCINA, Angers, France.,CHU Angers, Service d'Immunologie et Allergologie, Angers, France
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Vázquez-Otero I, Medina-Cintrón N, Arroyo-Ávila M, González-Sepúlveda L, Vilá LM. Clinical impact of hydroxychloroquine dose adjustment according to the American Academy of Ophthalmology guidelines in systemic lupus erythematosus. Lupus Sci Med 2021; 7:7/1/e000395. [PMID: 32434863 PMCID: PMC7245425 DOI: 10.1136/lupus-2020-000395] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/25/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022]
Abstract
Objective The American Academy of Ophthalmology recommends a maximum hydroxychloroquine (HCQ) dose of ≤5.0 mg/kg/day to reduce the risk of HCQ-induced retinopathy. To determine if this dose adjustment would have an impact on the clinical course of SLE, we compared outcome measures in a cohort of patients with SLE before and after adjusting HCQ dose. Methods Sixty Puerto Ricans with SLE (per 1997 American College of Rheumatology criteria) treated with HCQ who were changed to HCQ ≤5.0 mg/kg/day were studied. Visits were ascertained every 6 months for 2 years before and 2 years after HCQ dose adjustment (baseline visit). Disease activity (per Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), SLE exacerbations, emergency room visits, hospitalisations, disease damage (per Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), corticosteroids exposure, prednisone dose and immunosuppressive drugs exposure were determined before and after HCQ dose change. Results At baseline visit, the mean age was 43.8±15.1 years. All patients were women. The mean disease duration was 13.8±9.1 years. After HCQ dose adjustment, patients required a lower prednisone dose when compared with visits before HCQ dose reduction. No significant differences were observed for mean SLEDAI scores, lupus exacerbations, emergency room visits, hospitalisations, disease damage and exposure to immunosuppressive drugs before and after HCQ dose adjustment. Conclusions This study suggests that adjustment of daily HCQ dose to ≤5.0 mg/kg/day of actual body weight does not have a significant impact on the short-term and mid-term outcomes in this group of patients with SLE.
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Affiliation(s)
- Ileana Vázquez-Otero
- Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Nicolle Medina-Cintrón
- Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Mariangelí Arroyo-Ávila
- Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Lorena González-Sepúlveda
- Puerto Rico Clinical and Translational Research Consortium, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Luis M Vilá
- Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Lysosomal alkalization to potentiate eradication of intra-osteoblastic Staphylococcus aureus in the bone and joint infection setting. Clin Microbiol Infect 2021; 28:135.e1-135.e7. [PMID: 33962064 DOI: 10.1016/j.cmi.2021.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/13/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Beyond intracellular penetration, acidic lysosomal pH might affect the intracellular activity of some antimicrobials. This study evaluated the ability of lysosomotropic alkalizing agents to potentiate the antimicrobial eradication of an intra-osteoblastic Staphylococcus aureus reservoir in the setting of bone and joint infection (BJI). METHODS MICs of 16 anti-staphylococcal molecules active against methicillin-sensitive S. aureus (MSSA) were evaluated at pH 5 and pH 7. Additionally, the lysosomal alkalizing potential (spectrofluorometry) and cytotoxicity (MTT assay) of hydroxychloroquine, amantadine and ammonium chloride were assessed. The results led to further investigation of clindamycin, cotrimoxazole, daptomycin and levofloxacin-alone or in combination with hydroxychloroquine-in an in vitro model of osteoblast infection. The impact of hydroxychloroquine on autophagy was finally investigated using Western blot detection of two autophagic flux indicators, the LC3 membrane protein and the SQSTM1 cargo protein. RESULTS Daptomycin, cotrimoxazole, clindamycin and levofloxacin alone significantly decreased the intracellular staphylococcal reservoir (5.12 log10 CFU/100 000 cells) by 0.14 (95%CI 0.01-0.34), 0.25 (95%CI 0.12-0.43), 0.16 (95%CI 0.004-0.39) and 1.18 (95%CI 1.04-1.38) log10 CFU/100 000 cells, respectively (p < 10-3). Adding hydroxychloroquine (20 mg/L) increased intralysosomal pH from 4.8 to 7, and concomitantly the inoculum of each antimicrobial was reduced by 0.50 (95%CI 0.30-0.84), 0.73 (95%CI 0.59-0.96), 0.59 (95%CI 0.46-0.78) and 1.8 (95%CI 1.66-2.1) log10 CFU/100 000 cells, respectively (p < 10-4). Cellular levels of LC3II and SQSTM1 showed that hydroxychloroquine has direct activity on the autophagic flux, fostering the eradication of intracellular S. aureus by antimicrobials. CONCLUSION At high concentrations, hydroxychloroquine used as an adjuvant to antimicrobials improves eradication of an S. aureus intra-osteoblastic reservoir in our in vitro cell infection model. These findings advocate further in vivo evaluation of alkalization efficacy and tolerance in S. aureus BJI.
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42
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Randell RL, Singler L, Cunningham A, Schanberg LE, Cohen-Wolkowiez M, Hornik CP, Balevic SJ. Delivering clinical trials at home: protocol, design and implementation of a direct-to-family paediatric lupus trial. Lupus Sci Med 2021; 8:e000494. [PMID: 33963084 PMCID: PMC8108689 DOI: 10.1136/lupus-2021-000494] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Direct-to-family clinical trials efficiently provide data while reducing the participation burden for children and their families. Although these trials can offer significant advantages over traditional clinical trials, the process of designing and implementing direct-to-family studies is poorly defined, especially in children with rheumatic disease. This paper provides lessons learnt from the design and implementation of a self-controlled, direct-to-family pilot trial aimed to evaluate the effects of a medication management device on adherence to hydroxychloroquine in paediatric SLE. METHODS Several design features accommodate a direct-to-family approach. Participants meeting eligibility criteria from across the USA were identified a priori through a disease registry, and all outcome data are collected remotely. The primary outcome (medication adherence) is evaluated using electronic medication event-monitoring, plasma drug levels, patient questionnaires and pill counts. Secondary and exploratory endpoints include (1) lupus disease activity measured by a remote SLE Disease Activity Index examination and the Systemic Lupus Activity Questionnaire; and (2) hydroxychloroquine pharmacokinetics and pharmacodynamics. Recruitment of the initial target of 20 participants was achieved within 10 days. Due to initial recruitment success, enrolment was increased to 26 participants. Additional participants who were interested were placed on a waiting list in case of dropouts during the study. DISCUSSION AND DISSEMINATION Direct-to-family trials offer several advantages but present unique challenges. Lessons learnt from the protocol development, design, and implementation of this trial will inform future direct-to-family trials for children and adults with rheumatic diseases. Additionally, the data collected remotely in this trial will provide critical information regarding the accuracy of teleresearch in lupus, the impact of adherence to hydroxychloroquine on disease activity and a pharmacokinetic analysis to inform paediatric-specific dosing of hydroxychloroquine. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04358302).
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Affiliation(s)
- Rachel L Randell
- Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lindsay Singler
- Pediatrics, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Anthony Cunningham
- Pediatrics, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Laura E Schanberg
- Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Pediatrics, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Pediatrics, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Christoph P Hornik
- Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Pediatrics, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Stephen J Balevic
- Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Pediatrics, Duke Clinical Research Institute, Durham, North Carolina, USA
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Rosenbaum JT, Costenbader KH, Desmarais J, Ginzler EM, Fett N, Goodman SM, O'Dell JR, Schmajuk G, Werth VP, Melles RB, Marmor MF. American College of Rheumatology, American Academy of Dermatology, Rheumatologic Dermatology Society, and American Academy of Ophthalmology 2020 Joint Statement on Hydroxychloroquine Use With Respect to Retinal Toxicity. Arthritis Rheumatol 2021; 73:908-911. [PMID: 33559327 DOI: 10.1002/art.41683] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022]
Abstract
Four major medical societies involved with hydroxychloroquine (HCQ) therapy concur on the need for common principles and cooperation to minimize the risk of ocular toxicity. At a daily dosage of ≤5 mg/kg/day actual body weight, the risk of retinal toxicity from HCQ is <2% for usage up to 10 years. Widespread adoption of more sensitive testing techniques, such as optical coherence tomography and automated visual fields, by eye care providers will allow the detection of early toxicity and thus preserve the patient's visual function. Baseline testing is advised to rule out confounding disease when a patient is started on HCQ. Annual screening with sensitive tests should begin no more than 5 years after treatment initiation. Providers should be sensitive to the medical value of HCQ, and not stop the drug for uncertain indications. It is important to note that effective communication among prescribing physicians, patients, and eye care providers will optimize the utility and safety of HCQ.
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Affiliation(s)
- James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland
| | | | | | - Ellen M Ginzler
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Nicole Fett
- Oregon Health & Science University, Portland
| | - Susan M Goodman
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - James R O'Dell
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | - Victoria P Werth
- University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia
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Garg S, Unnithan R, Hansen KE, Costedoat-Chalumeau N, Bartels CM. Clinical Significance of Monitoring Hydroxychloroquine Levels in Patients With Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2021; 73:707-716. [PMID: 32004406 DOI: 10.1002/acr.24155] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Despite the pivotal role that hydroxychloroquine (HCQ) plays in treating systemic lupus erythematosus (SLE), less than 50% of patients take HCQ as prescribed. Measurement of HCQ blood levels can help clinicians distinguish nonadherence versus lack of efficacy of HCQ. Our objective was to systematically review publications and perform a meta-analysis to examine the correlation between HCQ levels and 1) nonadherence and 2) Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, in SLE. METHODS A comprehensive search was performed. We included observational and interventional studies that measured HCQ levels and assessed adherence or SLEDAI scores in adults with SLE. Forest plots compared pooled estimates of correlations between HCQ levels and reported nonadherence or SLEDAI scores. RESULTS Among 604 studies screened, 17 were reviewed. We found 3-times higher odds of reported nonadherence in patients with low HCQ levels (odds ratio 2.95 [95% confidence interval (95% CI) 1.63, 5.35], P < 0.001). The mean SLEDAI score was 3.14 points higher in groups with below-threshold HCQ levels on a priori analysis (δ = 3.14 [95% CI -0.05, 6.23], P = 0.053), and 1.4 points higher in groups with HCQ levels of <500 ng/ml (δ = 1.42 [95% CI 0.07, 2.76], P = 0.039). Among 1,223 patients, those with HCQ levels ≥750 ng/ml had a 58% lower risk of active disease, and their SLEDAI score was 3.2 points lower. CONCLUSION We found a strong association between low HCQ levels and reported nonadherence. Our results suggest that HCQ levels of ≥750 ng/ml might be a potential therapeutic target.
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Affiliation(s)
- Shivani Garg
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Rachna Unnithan
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Karen E Hansen
- University of Wisconsin School of Medicine and Public Health, Madison
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Salido EO, Tee CA, Reyes PWC, Reyes HBM, Zamora GT, Tee ML. Self-Reported Symptoms in a Cohort of Rheumatoid Arthritis and Systemic Lupus Erythematosus during the COVID-19 Quarantine Period. Open Rheumatol J 2021. [DOI: 10.2174/1874312902115010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background:
During the first three months of the COVID-19 pandemic in the Philippines, there was a supply shortage of hydroxychloroquine and methotrexate. Limited access to medication and the life changes resulting from the COVID-19 pandemic may predispose patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) to disease flares.
Objective:
This study aimed to investigate self-reported symptoms of disease flares among patients with rheumatoid arthritis or systemic lupus erythematosus during the COVID-19 pandemic.
Methods:
A total of 512 completed online surveys from patients with SLE or RA were collected. The data included sociodemographic characteristics, self-reported physical symptoms, health service utilization, and availability of hydroxychloroquine and methotrexate.
Results:
Seventy-nine percent of respondents had lupus, while 21% had RA. One-third of the cohort had contact with their attending physician during the two-month quarantine period prior to the survey. Eighty-two percent were prescribed hydroxychloroquine and 23.4% were prescribed methotrexate; but 68.6% and 65%, respectively, had “irregular” intake of these medicines due to unavailability. The current health status was reported as good by 66.2%; 24% had no symptoms during the two-week period prior to the survey. The most common symptoms experienced were joint pain (51%), muscle pain (35%), headache (26.8%), and skin rash (19.1%). Five percent had a combination of these four most common symptoms. Irregular supply of hydroxychloroquine among patients with SLE (n=323) was associated with more frequent occurrence of muscle pain (40.6% vs 27.9%, p=0.03) or rash (27.4% vs 11.7%, p<0.001). Irregular supply of methotrexate among RA patients prescribed hydroxychloroquine and methotrexate (n=36) was associated with more frequent occurrence of joint pains with or without swelling (73.9% vs 38.5%, p=0.04). Irregular supply of hydroxychloroquine was associated with less frequent occurrence of dizziness (0 vs 66.7%, p<0.001) among RA patients (n=18).
Conclusion:
In our cohort of RA and SLE, the majority reported at least one symptom that may indicate disease flare. There was a significant association between the irregular supply of hydroxychloroquine or methotrexate with the presence of muscle pain, rash, or joint pains during the 14-day period prior to the survey.
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Mejía-Vilet JM, Ayoub I. The Use of Glucocorticoids in Lupus Nephritis: New Pathways for an Old Drug. Front Med (Lausanne) 2021; 8:622225. [PMID: 33665199 PMCID: PMC7921306 DOI: 10.3389/fmed.2021.622225] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/20/2021] [Indexed: 12/19/2022] Open
Abstract
Glucocorticoids therapy has greatly improved the outcome of lupus nephritis patients. Since their discovery, their adverse effects have counterbalanced their beneficial anti-inflammatory effects. Glucocorticoids exert their effects through both genomic and non-genomic pathways. Differential activation of these pathways is clinically relevant in terms of benefit and adverse effects. Ongoing aims in lupus nephritis treatment development focus on a better use of glucocorticoids combined with immunosuppressant drugs and biologics. Newer regimens aim to decrease the peak glucocorticoid dose, allow a rapid glucocorticoid tapering, and intend to control disease activity with a lower cumulative glucocorticoid exposure. In this review we discuss the mechanisms, adverse effects and recent strategies to limit glucocorticoid exposure without compromising treatment efficacy.
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Affiliation(s)
- Juan M Mejía-Vilet
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico
| | - Isabelle Ayoub
- Division of Nephrology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Zhang M, Yao X, Hou Z, Guo X, Tu S, Lei Z, Yu Z, Liu X, Cui C, Chen X, Shen N, Song C, Qiao J, Xiang X, Li H, Liu D. Development of a Physiologically Based Pharmacokinetic Model for Hydroxychloroquine and Its Application in Dose Optimization in Specific COVID-19 Patients. Front Pharmacol 2021; 11:585021. [PMID: 33643034 PMCID: PMC7907647 DOI: 10.3389/fphar.2020.585021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023] Open
Abstract
In Feb 2020, we developed a physiologically-based pharmacokinetic (PBPK) model of hydroxychloroquine (HCQ) and integrated in vitro anti-viral effect to support dosing design of HCQ in the treatment of COVID-19 patients in China. This, along with emerging research and clinical findings, supported broader uptake of HCQ as a potential treatment for COVID-19 globally at the beginning of the pandemics. Therefore, many COVID-19 patients have been or will be exposed to HCQ, including specific populations with underlying intrinsic and/or extrinsic characteristics that may affect the disposition and drug actions of HCQ. It is critical to update our PBPK model of HCQ with adequate drug absorption and disposition mechanisms to support optimal dosing of HCQ in these specific populations. We conducted relevant in vitro and in vivo experiments to support HCQ PBPK model update. Different aspects of this model are validated using PK study from 11 published references. With parameterization informed by results from monkeys, a permeability-limited lung model is employed to describe HCQ distribution in the lung tissues. The updated model is applied to optimize HCQ dosing regimens for specific populations, including those taking concomitant medications. In order to meet predefined HCQ exposure target, HCQ dose may need to be reduced in young children, elderly subjects with organ impairment and/or coadministration with a strong CYP2C8/CYP2D6/CYP3A4 inhibitor, and be increased in pregnant women. The updated HCQ PBPK model informed by new metabolism and distribution data can be used to effectively support dosing recommendations for clinical trials in specific COVID-19 patients and treatment of patients with malaria or autoimmune diseases.
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Affiliation(s)
- Miao Zhang
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xueting Yao
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Zhe Hou
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Xuan Guo
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Siqi Tu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Zihan Lei
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Zhiheng Yu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Xuanlin Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Cheng Cui
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Xijing Chen
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Ning Shen
- Department of Respiratory, Peking University Third Hospital, Beijing, China
| | - Chunli Song
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Jie Qiao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Xiaoqiang Xiang
- Department of Clinical Pharmacy, School of Pharmacy, Fudan University, Shanghai, China
| | - Haiyan Li
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
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Dima A, Jurcut C, Arnaud L. Hydroxychloroquine in systemic and autoimmune diseases: Where are we now? Joint Bone Spine 2021; 88:105143. [PMID: 33515791 DOI: 10.1016/j.jbspin.2021.105143] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022]
Abstract
Hydroxychloroquine (HCQ), one of the oldest drugs used in rheumatology, came recently into attention as one of the potential therapies tested for the severe acute respiratory syndrome coronavirus-2 disease treatment. Used initially as an antimalarial, then translated to rheumatic diseases, HCQ has been used in a wide range of pathologies, including infectious diseases, immune disorders, diabetes, dyslipidemia, or neoplasia. Regarding systemic diseases, HCQ is the mainstay treatment for systemic lupus erythematosus (SLE), where, according to last European guidelines, it is proposed to all SLE patients unless contraindicated or with side effects. HCQ proved positive impact in SLE on robust outcomes, such as accrual damage, disease activity and survival, but also pleiomorphic effects, including decrease in the need for glucocorticoids, reduction in the risk of neonatal lupus, lower fasting glucose and protection against diabetes, thrombotic risk, dyslipidemia, infections, etc. Moreover, HCQ can be used during pregnancy and breast-feeding. Besides SLE, the role for HCQ in the anti-phospholipid syndrome and Sjögren's disease is still under debate. On the contrary, recent advances showed only limited interest for rheumatoid arthritis, especially due the lack of structural damage prevention. There are still no strong data to sustain the HCQ use in other systemic diseases. In this review, we summarised the utility and efficacy of HCQ in different clinical conditions relevant for rheumatology practice.
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Affiliation(s)
- Alina Dima
- Department of rheumatology, Colentina clinical hospital, 020125 Bucharest, Romania
| | - Ciprian Jurcut
- Department of internal medicine, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Laurent Arnaud
- National reference centre for rare auto-immune and systemic diseases Est Sud-Est (RESO), 67000 Strasbourg, France; Department of rheumatology, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France; Université de Strasbourg, Inserm UMR-S 1109, 67000 Strasbourg, France.
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Lenfant T, Salah S, Leroux G, Bousquet E, Le Guern V, Chasset F, Francès C, Morel N, Chezel J, Papo T, Cacoub P, Mouthon L, Guettrot-Imbert G, Cohen P, Régent A, Mauget-Faÿsse M, Piette JC, Jallouli M, Costedoat-Chalumeau N. Risk factors for hydroxychloroquine retinopathy in systemic lupus erythematosus: a case-control study with hydroxychloroquine blood-level analysis. Rheumatology (Oxford) 2021; 59:3807-3816. [PMID: 32442312 PMCID: PMC8186841 DOI: 10.1093/rheumatology/keaa157] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/05/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE HCQ is an essential medication in SLE, proven to lengthen survival and reduce flares. Its use, however, is limited by its rare but severe ophthalmological complications. Here, we aimed to analyse factors associated with HCQ retinopathy including HCQ blood levels. METHODS This case-control study compared SLE patients with and without HCQ retinopathy, defined by abnormal results for at least two of the following ophthalmological tests: automated visual fields, spectral-domain optical coherence tomography (SD-OCT), multifocal electroretinogram (mfERG) and fundus autofluorescence. We compared clinical and laboratory findings to assess risk factors for HCQ retinopathy. RESULTS The study included 23 patients with confirmed retinopathy (cases) and 547 controls. In the univariate analysis, age (P < 0.001), height (P = 0.045), creatinine clearance (P < 0.001), haemoglobin concentration (P = 0.01), duration of HCQ intake, (P < 0.001), higher cumulative HCQ dose (P < 0.001) and geographical origin (West Indies and sub-Saharan Africa) (P = 0.007) were associated with the risk of retinopathy, while HCQ blood levels were not. In the multivariate analysis, only cumulative dose (P = 0.016), duration of intake (P = 0.039), creatinine clearance (P = 0.002) and geographical origin (P < 0.0001, odds ratio 8.7) remained significantly associated with retinopathy. CONCLUSION SLE patients on HCQ should be closely monitored for retinopathy, especially those from the West Indies or sub-Saharan Africa, or with renal insufficiency, longer HCQ intake or a high cumulative dose. Although reducing the daily dose of HCQ in patients with persistently high HCQ blood levels seems logical, these concentrations were not associated with retinopathy in this study with controls adherent to treatment.
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Affiliation(s)
- Tiphaine Lenfant
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Sawsen Salah
- Department of Ophthalmology, Ophtalmopôle, Cochin Hospital, APHP
| | - Gaëlle Leroux
- Department of Internal Medicine and Clinical Immunology, Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Pitié-Salpêtrière University Hospital, APHP
| | - Elodie Bousquet
- Department of Ophthalmology, Ophtalmopôle, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris
| | - Véronique Le Guern
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - François Chasset
- Department of Dermatology and Allergology, Tenon Hospital, APHP.,Faculty of Medicine, Sorbonne University
| | - Camille Francès
- Department of Dermatology and Allergology, Tenon Hospital, APHP
| | - Nathalie Morel
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Julie Chezel
- Department of Internal Medicine, Bichat-Claude Bernard Hospital, APHP
| | - Thomas Papo
- Faculty of Medicine, Université de Paris.,Department of Internal Medicine, Bichat-Claude Bernard Hospital, APHP
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Pitié-Salpêtrière University Hospital, APHP.,Faculty of Medicine, Sorbonne University.,INSERM, UMR_S 959.,Paris CNRS, FRE3632
| | - Luc Mouthon
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris.,INSERM U1016, Équipe Neutrophiles et Vascularites, Institut Cochin
| | - Gaëlle Guettrot-Imbert
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Pascal Cohen
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Alexis Régent
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris
| | - Martine Mauget-Faÿsse
- Clinical Investigative Platform, Rothschild Ophthalmologic Foundation Hospital, Paris, France
| | - Jean-Charles Piette
- Department of Internal Medicine and Clinical Immunology, Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Pitié-Salpêtrière University Hospital, APHP
| | - Moez Jallouli
- Department of Internal Medicine, Hédi Chaker Sfax Hospital, Sfax, Tunisia
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris.,Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), INSERM U1153, Paris, France
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Ruiz-Irastorza G, Bertsias G. Treating systemic lupus erythematosus in the 21st century: new drugs and new perspectives on old drugs. Rheumatology (Oxford) 2021; 59:v69-v81. [PMID: 33280011 PMCID: PMC7719039 DOI: 10.1093/rheumatology/keaa403] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/05/2020] [Indexed: 12/14/2022] Open
Abstract
Besides treating acute flares, the management of SLE should aim at preventing organ damage accrual and drug-associated harms, improving health-related quality of life and prolonging survival. At present, therapy is based on combinations of antimalarials (mainly HCQ), considered the backbone of SLE treatment, glucocorticoids and immunosuppressive drugs. However, these regimens are not universally effective and a substantial degree of damage can be caused by exposure to glucocorticoids. In this review we provide a critical appraisal of the efficacy and safety of available treatments as well as a brief discussion of potentially novel compounds in patients with SLE. We emphasize the use of methylprednisolone pulses for moderate–severe flares, followed by low–moderate doses of oral prednisone with quick tapering to maintenance doses of ≤5 mg/day, as well as the prompt institution of immunosuppressive drugs in the setting of severe disease but also as steroid-sparing agents. Indications for the use of biologic agents, namely belimumab and rituximab, in refractory or organ-threatening disease are also presented. We conclude by proposing evidence- and experience-based treatment strategies tailored to the clinical scenario and prevailing organ involvement that can aid clinicians in managing this complex disease.
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Affiliation(s)
- Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Internal Medicine Department, Biocruces Bizkaia Health Research Institute, University of the Basque Country, Barakaldo, Bizkaia, Bilbao, Spain
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University of Crete Medical School and University Hospital of Iraklio, Iraklio, Greece
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