Low blood concentration of hydroxychloroquine in patients with refractory cutaneous lupus erythematosus: a French multicenter prospective study.

Abstract

OBJECTIVE:

To study the relation between blood concentration of hydroxychloroquine and the clinical efficacy of hydroxychloroquine sulfate in a series of patients with cutaneous lupus erythematosus (CLE).

DESIGN:

Prospective multicenter study. A staff dermatologist blinded to blood hydroxychloroquine concentrations performed a standardized review of medical records and assessment of hydroxychloroquine efficacy in the following 3 categories: complete remission, partial remission (clearing of >50% of skin lesions), or treatment failure. Whole-blood samples were collected for measurement of blood hydroxychloroquine concentration.

SETTING:

Fourteen French university hospitals.

PATIENTS:

Three hundred consecutive patients with subacute or chronic CLE who had been treated with hydroxychloroquine for at least 3 months.

MAIN OUTCOME MEASURES:

The statistical significance of correlation between blood hydroxychloroquine concentration and efficacy of hydroxychloroquine and the statistical associations in univariate and multivariate analyses of complete remission with several variables.

RESULTS:

The study included 300 patients with discoid lupus erythematosus (n = 160), subacute CLE (n = 86), lupus erythematosus tumidus (n = 52), chilblain lupus (n = 26), and lupus panniculitis (n = 16); 38 of these patients had 2 or more associated forms. Median blood hydroxychloroquine concentration was significantly higher in patients with complete remission (910 [range, <50 to 3057] ng/mL) compared with partial remission (692 [<50 to 2843] ng/mL) and treatment failure (569 [<50 to 2242] ng/mL) (P = .007). In the multivariate analysis, complete remission was associated with higher blood hydroxychloroquine concentrations (P = .005) and the absence of discoid lesions (P = .004). Thirty patients (10.0%) had very low blood hydroxychloroquine concentrations (<200 ng/mL) and may be considered nonadherent to the treatment regimen.

CONCLUSION:

Monitoring hydroxychloroquine blood concentrations might improve the management of refractory CLE.

• Authors: Camille Francès, Anne Cosnes, Pierre Duhaut, Noël Zahr, Boutros Soutou, Saskia Ingen-Housz-Oro, Didier Bessis, Jacqueline Chevrant-Breton, Nadège Cordel, Dan Lipsker, Nathalie Costedoat-Chalumeau
• Journal: Archives of dermatology (Arch Dermatol) Vol. 148 Issue 4 Pg. 479-84 (Apr 2012) ISSN: 1538-3652 [Electronic] United States
• PMID: 22508872 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Hydroxychloroquine

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antimalarials (blood, therapeutic use)
• Chilblains (drug therapy)
• Child
• Female
• France
• Humans
• Hydroxychloroquine (blood, therapeutic use)
• Lupus Erythematosus, Cutaneous (drug therapy)
• Male
• Medication Adherence
• Middle Aged
• Multivariate Analysis
• Panniculitis, Lupus Erythematosus (drug therapy)
• Prospective Studies
• Single-Blind Method
• Statistics, Nonparametric
• Treatment Outcome
• Young Adult