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J Am Acad Dermatol. 2016 Apr;74(4):693-9.e3. doi: 10.1016/j.jaad.2015.09.064. Epub 2016 Feb 3.

The effect of increasing the dose of hydroxychloroquine (HCQ) in patients with refractory cutaneous lupus erythematosus (CLE): An open-label prospective pilot study.

Author information

1
Assistance Publique Hôpitaux de Paris (AP-HP), Service de Dermatologie et d'Allergologie, Hôpital Tenon, F-75020, Paris, France.
2
Inserm Unité mixte de Recherche-S (UMR-S) 1136, Groupe Recherche (GR-08), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Pitié-Salpêtrière, F-75013, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris 06, F-75013, Paris, France.
3
Université René Descartes Paris V, F-75005, Paris, France; AP-HP, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne Pôle Médecine, Hôpital Cochin, F-75014, Paris, France.
4
AP-HP, Service de Pharmacologie, Hôpital Pitié-Salpêtrière, F-75013, Paris, France.
5
Université Montpellier, Service de Dermatologie, Centre Hospitalo-Universitaire de Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM) 1058, Montpellier, France.
6
Assistance Publique Hôpitaux de Paris (AP-HP), Service de Dermatologie et d'Allergologie, Hôpital Tenon, F-75020, Paris, France. Electronic address: camille.frances@tnn.aphp.fr.

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.

KEYWORDS:

antimalarials; cutaneous lupus erythematosus; hydroxychloroquine; hydroxychloroquine blood concentration; increasing dose; retinal toxicity

PMID:
26850655
DOI:
10.1016/j.jaad.2015.09.064
[Indexed for MEDLINE]

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