The effect of increasing the dose of hydroxychloroquine (HCQ) in patients with refractory cutaneous lupus erythematosus (CLE): An open-label prospective pilot study
Identifieur interne : 000119 ( France/Analysis ); précédent : 000118; suivant : 000120The effect of increasing the dose of hydroxychloroquine (HCQ) in patients with refractory cutaneous lupus erythematosus (CLE): An open-label prospective pilot study
Auteurs : François Chasset [France] ; Laurent Arnaud [France] ; Nathalie Costedoat-Chalumeau [France] ; Noël Zahr [France] ; Didier Bessis [France] ; Camille Francès [France]Source :
- Journal of The American Academy of Dermatology [ 0190-9622 ] ; 2016-04.
English descriptors
- mix :
Abstract
BACKGROUND:Up to 30% of patients with cutaneous lupus erythematosus (CLE) fail to respond to hydroxychloroquine (HCQ).OBJECTIVES:We sought to evaluate the efficacy of increased daily doses of HCQ on cutaneous response in refractory CLE.METHODS:We conducted an open-label prospective study between 2010 and 2014. Patients with CLE and HCQ blood level less than or equal to 750 ng/mL were included. The daily dose of HCQ was increased to reach blood concentrations greater than 750 ng/mL. The primary end point was the number of responders defined by an improvement of CLE Disease Area and Severity Index score (4 points or 20% decrease) in patients with HCQ blood concentration greater than 750 ng/mL.RESULTS:We included 34 patients (26 women; median age 45 [range 28-72] years). Two nonadherent patients were excluded. The median CLE Disease Area and Severity Index score before treatment was significantly improved after treatment (8 [range 2-30] vs 1.5 [range 0-30]), P < .001). The primary response criterion was reached in 26 (81%) of the 32 patients analyzed. A decrease in HCQ doses without further CLE flare (median follow-up 15.8 [range 3.06-77.4] months) was achieved in 15 of the 26 responders.LIMITATIONS:The main limitations of the study are its open-label design and the limited number of patients included.CONCLUSIONS:Increasing HCQ doses to reach blood concentrations greater than 750 ng/mL should be considered before addition of other treatments in refractory CLE.
Url:
DOI: 10.1016/j.jaad.2015.09.064
Affiliations:
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Hôpitaux de Paris (AP-HP)</orgName> <orgName type="acronym">APHP</orgName> <desc> <address> <country key="FR"></country> </address> </desc> </org></tutelle><tutelle active="#struct-328304" type="direct"><org type="institution" xml:id="struct-328304" status="VALID"> <orgName>CHU Tenon [APHP]</orgName> <desc> <address> <addrLine>4 Rue de la Chine, 75020 Paris</addrLine> <country key="FR"></country> </address> <ref type="url">http://www.aphp.fr/contenu/hopital-tenon-1</ref> </desc> </org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author></analytic><idno type="DOI">10.1016/j.jaad.2015.09.064</idno><series><title level="j">Journal of The American Academy of Dermatology</title><idno type="ISSN">0190-9622</idno><imprint><date type="datePub">2016-04</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="mix" xml:lang="en"><term>antimalarials</term><term>cutaneous lupus erythematosus</term><term>hydroxychloroquine</term><term>hydroxychloroquine blood concentration</term><term>increasing dose</term><term>retinal toxicity</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"> <p>BACKGROUND:Up to 30% of patients with cutaneous lupus erythematosus (CLE) fail to respond to hydroxychloroquine (HCQ).OBJECTIVES:We sought to evaluate the efficacy of increased daily doses of HCQ on cutaneous response in refractory CLE.METHODS:We conducted an open-label prospective study between 2010 and 2014. Patients with CLE and HCQ blood level less than or equal to 750 ng/mL were included. The daily dose of HCQ was increased to reach blood concentrations greater than 750 ng/mL. The primary end point was the number of responders defined by an improvement of CLE Disease Area and Severity Index score (4 points or 20% decrease) in patients with HCQ blood concentration greater than 750 ng/mL.RESULTS:We included 34 patients (26 women; median age 45 [range 28-72] years). Two nonadherent patients were excluded. The median CLE Disease Area and Severity Index score before treatment was significantly improved after treatment (8 [range 2-30] vs 1.5 [range 0-30]), P < .001). The primary response criterion was reached in 26 (81%) of the 32 patients analyzed. A decrease in HCQ doses without further CLE flare (median follow-up 15.8 [range 3.06-77.4] months) was achieved in 15 of the 26 responders.LIMITATIONS:The main limitations of the study are its open-label design and the limited number of patients included.CONCLUSIONS:Increasing HCQ doses to reach blood concentrations greater than 750 ng/mL should be considered before addition of other treatments in refractory CLE.</p> </div></front></TEI><affiliations><list><country><li>France</li></country></list><tree><country name="France"><noRegion><name sortKey="Chasset, Francois" sort="Chasset, Francois" uniqKey="Chasset F" first="François" last="Chasset">François Chasset</name></noRegion><name sortKey="Arnaud, Laurent" sort="Arnaud, Laurent" uniqKey="Arnaud L" first="Laurent" last="Arnaud">Laurent Arnaud</name><name sortKey="Bessis, Didier" sort="Bessis, Didier" uniqKey="Bessis D" first="Didier" last="Bessis">Didier Bessis</name><name sortKey="Costedoat Chalumeau, Nathalie" sort="Costedoat Chalumeau, Nathalie" uniqKey="Costedoat Chalumeau N" first="Nathalie" last="Costedoat-Chalumeau">Nathalie Costedoat-Chalumeau</name><name sortKey="Frances, Camille" sort="Frances, Camille" uniqKey="Frances C" first="Camille" last="Francès">Camille Francès</name><name sortKey="Zahr, Noel" sort="Zahr, Noel" uniqKey="Zahr N" first="Noël" last="Zahr">Noël Zahr</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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