ACR: Low-Dose Hydroxychloroquine Tied to More Hospitalizations for Lupus Flares

FRIDAY, Nov. 18, 2022 (HealthDay News) -- Patients with systemic lupus erythematosus (SLE) who are treated with lower doses of hydroxychloroquine (HCQ) have an increased risk for hospitalizations for SLE flares, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 10 to 14 in Philadelphia.

In a case-crossover study, Jacquelyn Nestor, M.D., Ph.D., from Massachusetts General Hospital in Boston, and colleagues assessed the impact of HCQ dose on the risk for hospitalizations for SLE flares. The analysis included 2,971 patients with SLE who used HCQ during 2011 through 2021. Case periods were defined as six months prior to an SLE hospitalization, while control periods were defined as nonoverlapping six-month periods without an SLE hospitalization.

The researchers found that 576 patients had at least one hospitalization with a primary discharge diagnosis of SLE. One hundred eight of these patients were hospitalized for an SLE flare while using HCQ and had one or more control periods with HCQ use during the study period. Both weight-based, low-dose HCQ (≤5 versus 5 mg/kg/day) and non-weight-based, low-dose HCQ (<400 versus 400 mg/day) were associated with increased hospitalizations for SLE (adjusted odds ratios, 4.41 and 3.48, respectively).

"The results of the study confirmed our hypothesis. We know that hydroxychloroquine has many proven benefits in SLE patients, so it seemed likely there would be a dose-effect as well," Nestor said in a statement. "The current guidelines are for hydroxychloroquine dosing by weight, which are in place to prevent the long-term potential side effect of blindness. But our study shows that lower dosing results in increased SLE-related hospitalization in the short-term. It may be worth reconsidering the current hydroxychloroquine dosing guidelines to balance both the short- and long-term side effects."

Several authors disclosed financial ties to pharmaceutical and biotechnology companies.

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