Older Lupus patients can safely avoid HCQ without increased
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Although hydroxychloroquine (HCQ) is a mainstay of treatment for patients with systemic lupus erythematosus (SLE), ocular toxicity can result from accumulated exposure. As the longevity of patients with SLE improves, data are needed to balance the risk of ocular toxicity and the risk of disease flare, especially in older patients with quiescent disease. Accordingly, this study was initiated to examine the safety of HCQ withdrawal in older SLE patients.

Five out of 26 patients in the HCQ withdrawal group compared to five in the HCQ continuation group experienced a flare of any severity. There were no severe flares in either group. The results were similar after adjusting for length of SLE, a number of American College of Rheumatology criteria. The analysis of time to any flare revealed a non-significant earlier time to flare in the HCQ withdrawal group. Most flares were in the cutaneous and musculoskeletal systems, but one patient in the continuation group developed pericarditis. The most common reason for HCQ withdrawal was retinal toxicity, followed by the patient’s preference, other confirmed or suspected adverse effects, ophthalmologist recommendation for macular degeneration, and rheumatologist recommendation for quiescent SLE.

In summary, despite its limitations, data from this multicenter retrospective study showed that the withdrawal of HCQ in stable SLE patients older than 55 did not result in a significant increase in flares compared to matched controls. Further prospective studies will be needed to confirm these reassuring observations and to assess the potential differences in metabolic, thrombotic, and mortality outcomes from HCQ withdrawal in the elderly lupus population. Evaluation of biomarkers to identify potential predictors of flares in older lupus patients should also be considered in future studies.

Source: https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-020-02282-0