ydroxychloroquine blood levels predicts flare in childhood-onset lupus nephriti

Autor(es):Mostrar menos -

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]

Afiliação do(s) autor(es)

^[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

• Tipo de documento: Artigo Científico
• Fonte: Lupus; v. 31, n. 1 DEC 2021.
• Citações Web of Science: 0

Resumo

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)

• Processo FAPESP: 17/14352-7 - Avaliação da relevância dos níveis sanguíneos de drogas utilizadas em doenças autoimunes reumatológicas no acompanhamento da segurança, eficácia e aderência à terapêutica
• Beneficiário: Tatiana Do Nascimento Pedrosa
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 15/03756-4 - Avaliação da relevância dos níveis sanguíneos de drogas utilizadas em doenças autoimunes reumatológicas no acompanhamento da segurança, eficácia e aderência à terapêutica
• Beneficiário: Eloisa Silva Dutra de Oliveira Bonfá
• Modalidade de apoio: Auxílio à Pesquisa - Temático