From the Guidelines
Hydroxychloroquine is a crucial medication for managing systemic lupus erythematosus (SLE), as it reduces inflammation, modulates immune system activity, and protects against ultraviolet light damage, with benefits including reduced frequency and severity of flares, decreased organ damage, and improved survival rates 1.
Key Benefits of Hydroxychloroquine in SLE
- Reduces flare rates and slows progression of kidney disease
- Lowers incidence of cardiovascular and thrombotic events in patients with antiphospholipid antibodies
- Lessens organ damage and improves lipid profile
- Preserves bone mass and has a satisfactory safety profile in pregnancy
Dosage and Administration
The recommended starting dose of hydroxychloroquine is around 5 mg/kg/d, with doses of 2–3 mg/kg/d potentially associated with higher flare rates 1.
Monitoring and Precautions
Regular eye exams are necessary to monitor for rare retinal toxicity, with the risk of retinopathy increasing with duration of treatment, dose, chronic kidney disease, and pre-existing retinal or macular disease 1.
Conclusion is not allowed, so the answer will continue without one.
The medication should be used with caution in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, and measurement of G6PD levels is preferred in men, especially those of African, Asian, or Middle Eastern origin, before starting hydroxychloroquine 1.
Quality of Life and Mortality
Hydroxychloroquine has been associated with improved quality of life and reduced mortality in patients with SLE, with low-certainty observational studies indicating potential kidney benefits and protective effects against infection 1. The potential benefits of preventing organ damage and vascular complications are judged as being important to patients, and the relatively low risk of adverse events associated with hydroxychloroquine would also be important to patients 1. Most patients should continue hydroxychloroquine indefinitely, even during pregnancy, as stopping can lead to disease flares 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
- 3 Systemic Lupus Erythematosus Hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus in adults.
The FDA drug label states that hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus (SLE) in adults, but it does not provide information on how it helps with SLE. 2
From the Research
Mechanism of Action
- Hydroxychloroquine (HCQ) has immune modulation effects that are beneficial for maintaining remission of systemic lupus erythematosus (SLE) and ameliorating skin, joint, and other manifestations 3.
- HCQ is useful in almost all manifestations of lupus and is first-line treatment unless contraindicated 4.
Treatment Outcomes
- The use of HCQ at stable doses of 200 mg/day (or 3.0-3.5 mg/kg/day) as background therapy in patients with SLE can lead to prolonged remission in the majority of patients 5.
- HCQ has been associated with a significant reduction in mortality in SLE patients 6.
- Treatment with HCQ can reduce disease activity, morbidity, and mortality in SLE patients 6.
Administration and Dosage
- The mean starting dose of HCQ was 206 mg/day, and the mean weight-adjusted starting dose of HCQ was 3.1 mg/kg/day 5.
- The dose of HCQ did not differ between patients who achieved prolonged remission and those who did not 5.
- HCQ should be administered to every lupus patient irrespective of organ involvement 7.