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TOPLINE:

Prolonged remission was observed in 72% of patients with systemic lupus erythematosus (SLE) who were treated with a consistent 200 mg daily dose of hydroxychloroquine.

METHODOLOGY:

• Researchers conducted an observational study using data from the Lupus-Cruces cohort to evaluate the daily and weight-adjusted dosages of hydroxychloroquine and their effects on long-term remission in patients with SLE.
• The study included 150 patients with SLE (mean age at diagnosis, 41 years; 80.7% women) who were followed for at least 5 years. Patients were excluded if they did not receive hydroxychloroquine or died before 5 years of follow-up.
• The primary outcome was remission, assessed annually using the definitions of remission in SLE (DORIS) criteria. Prolonged remission, defined as meeting DORIS criteria for five consecutive years, was also evaluated.
• Analyses were stratified by baseline SLE Disease Activity Index scores, classified as mild, moderate, or severe, and by diagnosis year, grouped into four periods: 2001-2005, 2006-2010, 2011-2015, and 2016-2018.
• Furthermore, associations between hydroxychloroquine doses and prednisone doses, immunosuppressive use, and mepacrine use were explored.

TAKEAWAY:

• The mean weight-adjusted hydroxychloroquine dose was 3.1 mg/kg/day at treatment initiation and 2.9 mg/kg/day during follow-up, with 99% of patients receiving < 5 mg/kg/day. The doses were comparable across subgroups stratified by year and disease activity.
• Prolonged remission occurred in 72% of patients, and initial weight-adjusted hydroxychloroquine doses did not significantly differ between those who achieved remission at 1 year and those who did not or between those who achieved prolonged remission and those who did not.
• Mean prednisone doses did not significantly differ by weight-adjusted hydroxychloroquine dosage at the 1-year or 5-year follow-up. Similarly, mean weight-adjusted doses of hydroxychloroquine remained unchanged in patients regardless of immunosuppressive or mepacrine treatment.
• Hydroxychloroquine treatment was maintained in 98% of patients over 5 years, with a mean duration of 58 months per patient.

IN PRACTICE:

"With the use of HCQ [hydroxychloroquine] at stable doses of 200 mg/day (or 3.0-3.5 mg/kg/day) as the background therapy, more than 70% of inception patients with SLE in our cohort achieved prolonged remission," the authors concluded.

SOURCE:

The study was led by Guillermo Ruiz-Irastorza, Biobizkaia Health Research Institute, Barakaldo, Spain. It was published online on February 26, 2025, in Lupus Science & Medicine.

LIMITATIONS:

The study could not compare the clinical course of patients receiving hydroxychloroquine doses lower and higher than 200 mg/day (or 5 mg/kg/day). Additionally, the study primarily included White participants and those with obesity, possibly limiting the generalisability of the findings to more diverse populations, including Black patients who may experience more severe forms of the disease.

DISCLOSURES:

One author reported receiving support from the Department of Education of the Basque Government. No relevant conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.