Therapeutic Hydroxychloroquine Blood Levels Are Associated With Fewer Hospitalizations and Possible Reduction of Health Disparities in Lupus
Year: 2024
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Nonadherence to receiving hydroxychloroquine (HCQ) is associated with a three-fold higher risk of lupus-related hospitalization. Monitoring HCQ blood levels could improve adherence to receiving HCQ and efficacy. Yet, HCQ level monitoring is not routinely done partially due to cost and coverage concerns. To establish HCQ level monitoring cost-effectiveness, we reported the following: (1) risk of acute care by HCQ blood levels, and (2) cost of HCQ monitoring versus acute care visits. METHODS: HCQ blood levels were measured during routine lupus visits. HCQ levels were categorized as follows: (1) subtherapeutic (<750 ng/mL), (2) therapeutic (750-1,200 ng/mL), or (3) supratherapeutic (>1,200 ng/mL). All lupus-related acute care visits (emergency room visits/hospitalizations) after the index clinic visit until next follow-up were abstracted. In our primary analysis, we examined associations between HCQ levels and time to first acute care visit in all patients and subgroups with higher rates of acute care. RESULTS: A total of 39 lupus-related acute care visits were observed in 181 patients. Therapeutic HCQ blood levels were associated with 66% lower rates of acute care. In our cohort, two groups, Black or Hispanic patients and those with public insurance, faced three to four times higher rates of acute care. Levels within 750 to 1,200 ng/mL were associated with 95% lower rates of acute care use in subgroups with higher acute care use. CONCLUSION: HCQ blood levels within 750 to 1,200 ng/mL are associated with lower rates of acute care in all patients with lupus, including groups with higher rates of acute care. Future clinical trials should establish the causal association between HCQ level monitoring and acute care in patients with lupus.
Source: Arthritis Care & Research
DOI: 10.1002/acr.25422
Institution: University of Wisconsin–Madison
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,640
Funders: Lupus Foundation of America, National Institutes of Health, Institute for Clinical and Translational Research, University of Wisconsin, Madison, National Cancer Institute, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Center for Advancing Translational Sciences
Awards: G115506582, MITF: Regulating Osteoclast Gene Expression and Function, Epigenetic modulation of T cell tolerance in Multiple Sclerosis autoimmunity, The Ohio State University Center for clinical and Translational Science, Understanding the role of EZH2 misregulation in chromatin crosstal, G5409860367, Novel Epigenetic Modifier Inhibitor Drugs for T cell Modulation in Multiple Sclerosis, Osteoclast precursors in bone homeostasis and inflammatory arthritis, University of Wisconsin Institute for Clinical and Translational Research, Cancer Center Support Grant, Short term training for veterinary students
OpenAlex ID: W4401928929