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(Reference retrieved automatically from Web of Science through information on FAPESP grant and its corresponding number as mentioned in the publication by the authors.)

ydroxychloroquine blood levels predicts flare in childhood-onset lupus nephriti

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Balbi, Verena Andrade [1] ; Silva, Clovis Artur [2] ; Pedrosa, Tatiana Nascimento [1] ; Rodrigues Pereira, Rosa Maria [2] ; de Arruda Campos, Lucia Maria [2] ; Leon, Elaine Pires [3] ; Duarte, Nilo [4] ; Carvalho, Valdemir Melechco [5] ; Pasoto, Sandra Gofint [3] ; do Rosario, Debora Cordeiro [3] ; Brandao, Leticia Kolachinski [3] ; Brunner, I, Hermine ; Bonfa, Eloisa [4] ; Aikawa, Nadia Emi [1]
Total Authors: 14
Affiliation:
[1] Univ Sao Paulo, Rheumatol Unit, Fac Med, Inst Crianca, Av Dr Arnaldo 455, 3rd Floor, Room 3190, BR-05403000 Sao Paulo - Brazil
[2] Univ Sao Paulo, Fac Med, Pediat, Sao Paulo - Brazil
[3] Univ Sao Paulo, Hosp Clin HCFMUSP, Rheumatol Div, Fac Med, Sao Paulo - Brazil
[4] Univ Sao Paulo, Hosp Clin HCFMUSP, Div Cent Lab, Fac Med, Sao Paulo - Brazil
[5] Fleury Grp, Fleury, Sao Paulo - Brazil
Total Affiliations: 5
Document type: Journal article
Source: Lupus; v. 31, n. 1 DEC 2021.
Web of Science Citations: 0
Abstract

Objective Low hydroxychloroquine (HCQ) blood levels are predictors of flare in adult lupus. Childhood-onset systemic lupus erythematosus (cSLE) has high morbidity with renal involvement in up to 80% of cases. The aim of this study is to determine the HCQ cut-off levels which predicts flare in childhood-onset lupus nephritis (LN). Methods Sixty LN patients on HCQ use for at least 6-months were prospectively evaluated at baseline (BL) and about 6-months later for cSLE flare and HCQ blood levels (ng/mL) measured by liquid chromatography-tandem mass spectrometry. Results There were 19 patients (32%) with flare, during the study with median SLEDAI increase of 4 (0-8). Median (IQR) BL HCQ levels of the flare group were lower compared to stable patients {[}557.5 (68.6-980.3) vs. 1061.9 (534.8-1590.0 ng/mL); p=0.012]. ROC curve analysis demonstrated that HCQ levels <= 1075 ng/mL were associated with a 5.08 (95%CI 1.28-20.13; p=0.021) times increased risk of flare. Six-month HCQ levels revealed that most patients 24/54 (44%) had persistently low levels (<= 1075) during follow-up. Among those, 11/24 (46%) had flare. Multiple logistic regression analysis including prednisone use, baseline SLEDAI-2K, adherence based on pharmacy refill and BL HCQ blood levels as possible predictors of flare revealed that only HCQ blood level was independently associated with flare (OR 0.999, 95%CI 0.998-1.0, p=0.013). Conclusions We demonstrated that HCQ blood cut-off level under 1075 ng/mL predicts flare in childhood-onset LN patients under prescribed HCQ dose of 4.0-5.5 mg/kg/day. We further observed that most of these patients have compliance issues reinforcing the need for a close surveillance particularly in those with levels below the defined cut-off. (AU)

FAPESP's process: 17/14352-7 - Assessment of relevance of blood levels of drugs in the monitoring rheumatic autoimmune diseases: safety, effectiveness and adherence to therapy
Grantee:Tatiana Do Nascimento Pedrosa
Support Opportunities: Scholarships in Brazil - Post-Doctoral
FAPESP's process: 15/03756-4 - Assessment of relevance of blood levels of drugs in the monitoring rheumatic autoimmune diseases: safety, effectiveness and adherence to therapy
Grantee:Eloisa Silva Dutra de Oliveira Bonfá
Support Opportunities: Research Projects - Thematic Grants