Skip to main content
Erschienen in: Clinical Rheumatology 7/2018

26.04.2018 | Original Article

Sharp decline in hydroxychloroquine dosing—analysis of 17,797 initiators from 2007 to 2016

verfasst von: Ronald B. Melles, April M. Jorge, Michael F. Marmor, Yuqing Zhang, Hyon K. Choi

Erschienen in: Clinical Rheumatology | Ausgabe 7/2018

Einloggen, um Zugang zu erhalten

Abstract

We aimed to assess the impact of ophthalmology weight-based hydroxychloroquine (HCQ) dosing guidelines on prescribing patterns. We examined initial HCQ prescription dosing between 2007 and 2016 and determined independent predictors for HCQ dosing above the previous (2011) recommended ≤ 6.5 mg/kg of ideal body weight (IBW)/day and the latest (2016) recommended ≤ 5.0 mg/kg of actual body weight (ABW)/day using logistic regression. Among 17,797 patients (82% female), the proportion of 400 mg prescribed daily dosing declined sharply from 80% in 2007–2011 to nearly 40% in 2014, whereas the proportions of 200- and 300-mg daily doses showed the opposite trends during the same periods. Accordingly, the risk of HCQ dosing above the guideline recommendations declined by more than 60%. While 36% of normal body mass index (BMI) individuals were classified as dosing above the IBW-based guideline, 66% would have received dosing above the latest ABW-based guideline. The risk of excess dosing was associated with female patients and dermatology prescribers (adjusted odds ratios ≥ 2 according to IBW- or ABW-based guidelines). There has been a sharp decline in HCQ dosing following ophthalmology weight-based guidelines in recent years. While this trend is likely helpful in reducing the risk of retinopathy, its potential impact on HCQ efficacy remains to be clarified.
Literatur
1.
Zurück zum Zitat Ruiz-Irastorza G, Khamashta M (2008) Hydroxychloroquine: the cornerstone of lupus therapy. Lupus 17:271–273CrossRefPubMed Ruiz-Irastorza G, Khamashta M (2008) Hydroxychloroquine: the cornerstone of lupus therapy. Lupus 17:271–273CrossRefPubMed
2.
Zurück zum Zitat Bertsias G, Ioannidis JP, Boletis J, Bombardieri S, Cervera R, Dostal C, Font J, Gilboe IM, Houssiau F, Huizinga T, Isenberg D, Kallenberg CG, Khamashta M, Piette JC, Schneider M, Smolen J, Sturfelt G, Tincani A, van Vollenhoven R, Gordon C, Boumpas DT (2008) Task force of the ESCfICSITEULAR recommendations for the management of systemic lupus erythematosus Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 67(2):195–205. https://doi.org/10.1136/ard.2007.070367 CrossRefPubMed Bertsias G, Ioannidis JP, Boletis J, Bombardieri S, Cervera R, Dostal C, Font J, Gilboe IM, Houssiau F, Huizinga T, Isenberg D, Kallenberg CG, Khamashta M, Piette JC, Schneider M, Smolen J, Sturfelt G, Tincani A, van Vollenhoven R, Gordon C, Boumpas DT (2008) Task force of the ESCfICSITEULAR recommendations for the management of systemic lupus erythematosus Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 67(2):195–205. https://​doi.​org/​10.​1136/​ard.​2007.​070367 CrossRefPubMed
3.
Zurück zum Zitat Petri M (2011) Use of hydroxychloroquine to prevent thrombosis in systemic lupus erythematosus and in antiphospholipid antibody-positive patients. Curr Rheumatol Rep 13:77–80 Petri M (2011) Use of hydroxychloroquine to prevent thrombosis in systemic lupus erythematosus and in antiphospholipid antibody-positive patients. Curr Rheumatol Rep 13:77–80
5.
Zurück zum Zitat Bernatsky S, Boivin JF, Joseph L, Manzi S, Ginzler E, Gladman DD, Urowitz M, Fortin PR, Petri M, Barr S, Gordon C, Bae SC, Isenberg D, Zoma A, Aranow C, Dooley MA, Nived O, Sturfelt G, Steinsson K, Alarcon G, Senecal JL, Zummer M, Hanly J, Ensworth S, Pope J, Edworthy S, Rahman A, Sibley J, El-Gabalawy H, McCarthy T, St Pierre Y, Clarke A, Ramsey-Goldman R (2006) Mortality in systemic lupus erythematosus. Arthritis Rheum 54(8):2550–2557. https://doi.org/10.1002/art.21955 CrossRefPubMed Bernatsky S, Boivin JF, Joseph L, Manzi S, Ginzler E, Gladman DD, Urowitz M, Fortin PR, Petri M, Barr S, Gordon C, Bae SC, Isenberg D, Zoma A, Aranow C, Dooley MA, Nived O, Sturfelt G, Steinsson K, Alarcon G, Senecal JL, Zummer M, Hanly J, Ensworth S, Pope J, Edworthy S, Rahman A, Sibley J, El-Gabalawy H, McCarthy T, St Pierre Y, Clarke A, Ramsey-Goldman R (2006) Mortality in systemic lupus erythematosus. Arthritis Rheum 54(8):2550–2557. https://​doi.​org/​10.​1002/​art.​21955 CrossRefPubMed
7.
Zurück zum Zitat Cairoli E, Rebella M, Danese N, Garra V, Borba EF (2012) Hydroxychloroquine reduces low-density lipoprotein cholesterol levels in systemic lupus erythematosus: a longitudinal evaluation of the lipid-lowering effect. Lupus 21:1178–1182CrossRefPubMed Cairoli E, Rebella M, Danese N, Garra V, Borba EF (2012) Hydroxychloroquine reduces low-density lipoprotein cholesterol levels in systemic lupus erythematosus: a longitudinal evaluation of the lipid-lowering effect. Lupus 21:1178–1182CrossRefPubMed
11.
Zurück zum Zitat LG D, Munz SJ, Paschal J, Cohen HB, Pince KJ, Peterson T (1997) Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Arthritis Rheum 40(8):1482–1486CrossRef LG D, Munz SJ, Paschal J, Cohen HB, Pince KJ, Peterson T (1997) Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Arthritis Rheum 40(8):1482–1486CrossRef
17.
Zurück zum Zitat Devine B (1974) Case number 25: gentamicin therapy. Drug Intelligence and Clin Pharm 8:650–655CrossRef Devine B (1974) Case number 25: gentamicin therapy. Drug Intelligence and Clin Pharm 8:650–655CrossRef
21.
Zurück zum Zitat Anthropometric Reference Data for Children and Adults: United States, 2007–2010 (2012 Oct). US Department of Health and Human Services, CDC 11 (252) Anthropometric Reference Data for Children and Adults: United States, 2007–2010 (2012 Oct). US Department of Health and Human Services, CDC 11 (252)
23.
Zurück zum Zitat Frances C, Cosnes A, Duhaut P, Zahr N, Soutou B, Ingen-Housz-Oro S, Bessis D, Chevrant-Breton J, Cordel N, Lipsker D, Costedoat-Chalumeau N (2012) Low blood concentration of hydroxychloroquine in patients with refractory cutaneous lupus erythematosus: a French multicenter prospective study. Arch Dermatol 148(4):479–484. https://doi.org/10.1001/archdermatol.2011.2558 CrossRefPubMed Frances C, Cosnes A, Duhaut P, Zahr N, Soutou B, Ingen-Housz-Oro S, Bessis D, Chevrant-Breton J, Cordel N, Lipsker D, Costedoat-Chalumeau N (2012) Low blood concentration of hydroxychloroquine in patients with refractory cutaneous lupus erythematosus: a French multicenter prospective study. Arch Dermatol 148(4):479–484. https://​doi.​org/​10.​1001/​archdermatol.​2011.​2558 CrossRefPubMed
26.
Zurück zum Zitat Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82(5):703–710CrossRefPubMedPubMedCentral Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82(5):703–710CrossRefPubMedPubMedCentral
Metadaten
Titel
Sharp decline in hydroxychloroquine dosing—analysis of 17,797 initiators from 2007 to 2016
verfasst von
Ronald B. Melles
April M. Jorge
Michael F. Marmor
Yuqing Zhang
Hyon K. Choi
Publikationsdatum
26.04.2018
Verlag
Springer London
Erschienen in
Clinical Rheumatology / Ausgabe 7/2018
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-018-4116-0

Weitere Artikel der Ausgabe 7/2018

Clinical Rheumatology 7/2018 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.