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Hydroxychloroquine treatment in European patients with lupus erythematosus: dosing, retinopathy screening and adherence.
Lupus Sci Med. 2021 Mar; 8(1)LS

Abstract

BACKGROUND

Use of hydroxychloroquine (HCQ) is common in patients with lupus erythematosus. Long-term use (ie, ≥5 years) and high-dose HCQ (ie, >5 mg/kg/day) are both risk factors for developing HCQ retinopathy. Advances in our understanding of HCQ retinopathy have led to changes in the recommendations for HCQ dosing and retinopathy screening. The latest EULAR guidelines for the management of SLE recommend a maximum HCQ dose of 5 mg/kg/day and ophthalmological screening at baseline and annually after 5 years of HCQ treatment.

OBJECTIVES

This study aimed to assess whether the EULAR guidelines are affecting HCQ prescription patterns and screening frequencies in Europe. Furthermore, we inventoried adherence to HCQ.

RESULTS

The online questionnaire was completed by 2936 patients with systemic, cutaneous or juvenile lupus from 33 countries. The majority were female (86.5%) and diagnosed with SLE (81.2%). Among those taking HCQ, the median HCQ dose reported was 4.26 mg/kg/day. More than one-third of respondents (36.8%) exceeded the recommended maximal HCQ dose of 5 mg/kg/day. Baseline ophthalmological screening had been done in 857 out of 1017 respondents diagnosed in the past 10 years (84.3%). Of patients using HCQ ≥5 years, 69.2% reported yearly retinopathy screening. Lastly, 17.3% of patients reported that they skipped HCQ once a week or more often.

CONCLUSION

The results of our study demonstrate that higher than recommended dosages of HCQ are prescribed to more than one-third of patients with lupus in Europe. Recent recommendations regarding screening for retinopathy are incompletely implemented.

Authors+Show Affiliations

LUPUS/APS Committee, Dutch Patient Association NVLE, Utrecht, The Netherlands info@nvle.org. Lupus Europe, Romford, UK.Faculty of Medicine and Health Sciences, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands.LUPUS/APS Committee, Dutch Patient Association NVLE, Utrecht, The Netherlands. Lupus Europe, Romford, UK.Lupus Europe, Romford, UK.Lupus Europe, Romford, UK.Medical Advisory Board, Dutch Patient Association NVLE, Utrecht, The Netherlands.Lupus Europe, Romford, UK.Medical Advisory Board, Lupus Europe, Romford, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33795484

Citation

Osmani, Zgjim, et al. "Hydroxychloroquine Treatment in European Patients With Lupus Erythematosus: Dosing, Retinopathy Screening and Adherence." Lupus Science & Medicine, vol. 8, no. 1, 2021.
Osmani Z, Schrama TJ, Zacouris-Verweij W, et al. Hydroxychloroquine treatment in European patients with lupus erythematosus: dosing, retinopathy screening and adherence. Lupus Sci Med. 2021;8(1).
Osmani, Z., Schrama, T. J., Zacouris-Verweij, W., Andersen, J., Frankel, S., Bultink, I. E. M., Cornet, A., & van Vollenhoven, R. F. (2021). Hydroxychloroquine treatment in European patients with lupus erythematosus: dosing, retinopathy screening and adherence. Lupus Science & Medicine, 8(1). https://doi.org/10.1136/lupus-2021-000478
Osmani Z, et al. Hydroxychloroquine Treatment in European Patients With Lupus Erythematosus: Dosing, Retinopathy Screening and Adherence. Lupus Sci Med. 2021;8(1) PubMed PMID: 33795484.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hydroxychloroquine treatment in European patients with lupus erythematosus: dosing, retinopathy screening and adherence. AU - Osmani,Zgjim, AU - Schrama,Thijs J, AU - Zacouris-Verweij,Wendy, AU - Andersen,Jeanette, AU - Frankel,Susan, AU - Bultink,Irene E M, AU - Cornet,Alain, AU - van Vollenhoven,Ronald F, PY - 2021/01/14/received PY - 2021/02/18/revised PY - 2021/03/18/accepted PY - 2021/4/2/entrez PY - 2021/4/3/pubmed PY - 2021/9/18/medline KW - autoimmune diseases KW - autoimmunity KW - lupus erythematosus KW - systemic JF - Lupus science & medicine JO - Lupus Sci Med VL - 8 IS - 1 N2 - BACKGROUND: Use of hydroxychloroquine (HCQ) is common in patients with lupus erythematosus. Long-term use (ie, ≥5 years) and high-dose HCQ (ie, >5 mg/kg/day) are both risk factors for developing HCQ retinopathy. Advances in our understanding of HCQ retinopathy have led to changes in the recommendations for HCQ dosing and retinopathy screening. The latest EULAR guidelines for the management of SLE recommend a maximum HCQ dose of 5 mg/kg/day and ophthalmological screening at baseline and annually after 5 years of HCQ treatment. OBJECTIVES: This study aimed to assess whether the EULAR guidelines are affecting HCQ prescription patterns and screening frequencies in Europe. Furthermore, we inventoried adherence to HCQ. RESULTS: The online questionnaire was completed by 2936 patients with systemic, cutaneous or juvenile lupus from 33 countries. The majority were female (86.5%) and diagnosed with SLE (81.2%). Among those taking HCQ, the median HCQ dose reported was 4.26 mg/kg/day. More than one-third of respondents (36.8%) exceeded the recommended maximal HCQ dose of 5 mg/kg/day. Baseline ophthalmological screening had been done in 857 out of 1017 respondents diagnosed in the past 10 years (84.3%). Of patients using HCQ ≥5 years, 69.2% reported yearly retinopathy screening. Lastly, 17.3% of patients reported that they skipped HCQ once a week or more often. CONCLUSION: The results of our study demonstrate that higher than recommended dosages of HCQ are prescribed to more than one-third of patients with lupus in Europe. Recent recommendations regarding screening for retinopathy are incompletely implemented. SN - 2053-8790 UR - https://www.unboundmedicine.com/medline/citation/33795484/full_citation DB - PRIME DP - Unbound Medicine ER -