ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 744

Factors Related to Blood Hydroxychloroquine Concentration in Patients with Systemic Lupus Erythematosus

Ji Yeon Lee1, Jennifer Lee2, Seung-Ki Kwok3, Ji Hyeon Ju4, Kyung-Su Park5 and Sung-Hwan Park4, 1International Healthcare Center, Seoul St Mary's Hosiptal, Seoul, Korea, Republic of, 2Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of, 3[email protected], Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea, 4Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea, 5Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea, The Republic of

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Sunday, November 13, 2016

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster I: Clinical Trial Design and Current Therapies

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:  To identify factors associated with blood concentrations of hydroxychloroquine (HCQ) and its major metabolite, N-desethylhydroxychloroquine (DHCQ), in patients with systemic lupus erythematosus (SLE) receiving long-term oral HCQ treatment.

Methods:  SLE patients who had been taking HCQ for more than 3 months were recruited. Various clinical characteristics, laboratory values, and SLE disease activity index (SLEDAI) scores were examined. The concentration of HCQ and DHCQ ([HCQ] and [DHCQ]) was measured by liquid chromatography-mass spectrometry, and the relationship between [HCQ], [DHCQ], and [HCQ]/[DHCQ] ratio to various factors was investigated.

Results:  In total, 189 SLE patients on long-term HCQ treatment were included in the analysis. The median [HCQ] was 515 (353~720) ng/ml, the median [DHCQ] was 417 (266~591) ng/ml, and the median [HCQ]/[DHCQ] ratio was 1.3 (1.0~1.7). [HCQ] was closely associated with [DHCQ] (r=0.81, p<0.0001). The weight-adjusted oral HCQ dose was strongly associated with both [HCQ] (p<0.001) and [DHCQ] (p<0.001). Time from last dose was associated with [HCQ] (p<0.001). No statistically significant association was found between renal function or smoking and [HCQ] or [DHCQ]. Additional use of immunosuppressants increased both [HCQ] and [DHCQ] after adjusting for possible confounders (p=0.04, 0.03). The lower SLEDAI score was significantly related to higher [HCQ] after adjusting for age, gender, weight adjusted HCQ dose, time from last dose, number of other immunosuppressants, and smoking status (p=0.007) (see table).

Conclusion:  Various factors affected [HCQ], [DHCQ], or the [HCQ]/[DHCQ] ratio in the blood of SLE patients on long-term oral HCQ treatment. Notably, a higher [HCQ] was associated with a lower SLEDAI score, in our typical outpatient clinic population with lupus.

Table. Association between several factors and HCQ, DHCQ concentrations

[HCQ]ǂ

[DHCQ]ǂ

[HCQ]/[DHCQ]ǂ

Estimate

p-value

Estimate p-value Estimate p-value

Smoking2

0.28

0.10

0.29

0.16

-0.01

0.94

Smoking6

0.31

0.08°

0.28

0.17

0.02

0.85

# other meds2

1

0.14

0.09°

0.18

0.07°

-0.04

0.54

2

0.18

0.40

0.38

0.13

-0.21

0.20

# other meds5

1

0.16

0.04*

0.21

0.03*

-0.05

0.44

2

0.21

0.32

0.41

0.11

-0.19

0.24

Corticosteroid dose 2

<=2.5mg/d

reference

reference

reference

>2.5, <=5mg/d

0.03

0.70

0.03

0.77

0.003

0.97

>5, <=7.5mg/d

-0.05

0.66

-0.20

0.15

0.15

0.08°

>7.5mg/d

-0.19

0.10

-0.24

0.08°

0.05

0.55

Corticosteroid dose 7

<=2.5mg/d

reference

reference

reference

>2.5,<=5mg/d

0.06

0.49

0.02

0.86

0.04

0.54

>5, <=7.5mg/d

-0.03

0.77

-0.23

0.11

0.19

0.04*

>7.5mg/d

-0.11

0.38

-0.23

0.12

0.12

0.19

SLEDAI score1

-0.002

0.9

0.01

0.50

-0.01

0.17

SLEDAI score2

-0.03

0.03*

-0.02

0.27

-0.01

0.28

SLEDAI score3

-0.04

0.007**

-0.03

0.09°

-0.01

0.39

SLEDAI score4

-0.03

0.03*

-0.02

0.35

-0.02

0.16

HCQ, hydroxychloroquine; DHCQ, desethylhydroxychloroquine

ǂLog transformed for analyses

°p<0.10

*p<0.05

**p<0.01

1Unadjusted.

2Adjusted for age, gender, dose/kg/day, and time from last dose.

3Adjusted for age, gender, dose/kg/day, time from last dose, number of other immunosuppressants, and smoking status.

4Adjusted for age, gender, dose/kg/day, time from last dose, number of other immunosuppressants, smoking status, and corticosteroid dose.

5Adjusted for age, gender, dose/kg/day, time from last dose, SLEDAI score, smoking status, and corticosteroid dose.

6Adjusted for age, gender, dose/kg/day, time from last dose, number of other immunosuppressants, SLEDAI score, and corticosteroid dose.

7Adjusted for age, gender, dose/kg/day, time from last dose, number of other immunosuppressants, SLEDAI score, and smoking status.

Disclosure: J. Y. Lee, None; J. Lee, None; S. K. Kwok, None; J. H. Ju, None; K. S. Park, None; S. H. Park, None.

To cite this abstract in AMA style:

Lee JY, Lee J, Kwok SK, Ju JH, Park KS, Park SH. Factors Related to Blood Hydroxychloroquine Concentration in Patients with Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/factors-related-to-blood-hydroxychloroquine-concentration-in-patients-with-systemic-lupus-erythematosus/. Accessed .

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