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High Doses of Hydroxychloroquine May Protect Against Thrombosis in SLE

lupus-support1
lupus-support1Administrator
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High Doses of Hydroxychloroquine May Protect Against Thrombosis in SLE

Emily Pond

Hydroxychloroquine has been known to have a primary role in the treatment of systemic lupus erythematosus.

The following article is a part of conference coverage from the 2019 American College of Rheumatology/The Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, being held in Atlanta, Georgia. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the 2019 ACR/ARP Annual Meeting.

ATLANTA — Higher prescribed doses of hydroxychloroquine (HCQ) may be associated with lower odds of thrombotic events in patients with systemic lupus erythematosus (SLE), according to study results presented at the 2019 The American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, held November 8 to 13, 2019, in Atlanta, Georgia.

Investigators conducted a prospective cohort study of patients with SLE, and HCQ blood levels were ascertained at study visits by liquid chromatography-tandem mass spectrometry. Thromboses were defined as venous, including deep vein thrombosis/pulmonary embolism, or arterial, including stroke, myocardial infarction digital gangrene, or other arterial thrombosis. Patients were followed-up until index thrombotic event. Mean HCQ blood levels were calculated by averaging values obtained at all cohort visits before thrombosis.

The study cohort comprised 812 patients with SLE, among whom 93% were women, 43% were black, and 46% were white. During follow-up, researchers observed thrombosis in 44 patients (5.4%): 3.0% with venous thrombosis and 2.5% with arterial thrombosis. Lupus anticoagulant was significantly associated with a prior history of any thrombosis (odds ratio [OR], 3.25; P <.0001), venous thrombosis (OR, 3.53; P <.0001), and arterial thrombosis (OR, 3.08; P <.0001). Mean HCQ blood levels were significantly reduced in patients with any thrombosis (P =.0393) and venous thrombosis (P =.0616 with superficial; P =.0249 without superficial), compared with patients with no thrombosis. In addition, higher prescribed doses of HCQ were associated with decreased odds of any thrombosis and venous thrombosis (OR, 0.88; P =.04 and OR, 0.83; P =.009, respectively, for each 1 mg/kg increase in HCQ dose).

In this prospective analysis, high HCQ blood levels appeared to be protective against thrombosis in patients with SLE. The American Academy of Ophthalmologists suggests that clinicians reduce HCQ dosing; however, such adjustments “could reduce or eliminate the benefit of [HCQ] to prevent thrombosis,” the investigators wrote.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Konig M, Li J, Petri M. Hydroxychloroquine blood levels and risk of thrombotic events in systemic lupus erythematosus. Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. Abstract 2783.

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Everyone taking hydroxychloroquine should see an ophthalmologist annually, to ensure there is no eye toxicity.

Please do not be alarmed. I have been taking it for over 20 years. At the first sign of any problem, the drug will be stopped!

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APsnotFab
APsnotFabAdministrator

Thanks for posting this.

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tashi

Does anyone know what the higher dose referred to in the study was? My Rheumy always states 400mg of hydroxychloroquine is the highest dose but I wondered if they were trialling anything higher?🤔

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lupus-support1
lupus-support1Administrator
in reply to tashi

I suggest you contact the researchers who wrote the paper:

Konig M, Li J, Petri M. Hydroxychloroquine blood levels and risk of thrombotic events in systemic lupus erythematosus. Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. Abstract 2783.

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hihannula
hihannula
in reply to tashi

Hi Tasha. If you do find out the dose, could you post please. I’m on 400mg as well and my Dr says that’s the normal. Cheers. Holly

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Tinkytink

I opted for hydroxy 400mg daily over mtx fir this reason. Lowers risk of thrombosis ( I have lupus anticoagulant) lowers bad cholesterol, doesn't damage lungs, and though takes ages to work seems to have more positives than negatives. I'm on week 9 or 10 so early days....

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