Hydroxychloroquine blood levels in stable lupus nephritis under low dose (2–3 mg/kg/day): 12-month prospective randomized controlled trial

Zanetti, Caio Bosquiero; Pedrosa, Tatiana do Nascimento; Kupa, Léonard de Vinci Kanda; Aikawa, Nádia E.; Borba, Eduardo Ferreira; Vendramini, Margarete Borges Galhardo; Silva, Clóvis A.; Pasoto, Sandra Gofinet; Bonfá, Eloísa

doi:10.1007/s10067-021-05600-2

Cited by 9 publications

(7 citation statements)

References 19 publications

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“…To date, HCQ have not been reliably linked to an increased incidence of infections as has been known to occur with use of other immunosuppressive drugs [43]. Higher dosage use of HCQ can cause retinal toxicity, thus a dosage of 0.5-0.6 mg/kg/day maximum is suggested [44]. Despite reports of the valuable clinical effects of antimalarial agents in SLE, we still need additional confirmation from clinical studies as well as more-detailed basic studies to decipher their mechanisms of action [43].…”

Section: Discussionmentioning

confidence: 99%

Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses

Smıth

Park

et al. 2022

JCM

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Background: Lupus nephritis (LN) is present in over 50% of patients with systemic lupus erythematosus (SLE) which is managed with immunosuppressive and immunomodulatory therapies. However, several novel therapeutic approaches for LN are under investigation due to the adverse effects spectrum of conventional therapy; Methods: We performed a comprehensive review of meta-analyses aggregating the comparative efficacies of various pharmacotherapies for LN. We conducted a literature search and retrieved a total of 23 meta-analyses and network meta-analyses for summarization. Pharmacotherapies were evaluated across six major outcomes: remission, relapse, mortality, end stage kidney disease (ESKD) progression, infection, and malignancy. Result: Calcineurin inhibitors (CNI), particularly tacrolimus (TAC), in combination with glucocorticoids (GC) outperformed cyclophosphamide (CPA) with GC in the rate of remission, either complete or partial remission, and in terms of infectious complications. In maintenance therapy, MMF was superior to azathioprine (AZA) as the MMF-treated patients had lower relapse rate. Interpretation: This review aggregates evidence of therapy for clinicians and sheds light on comparative efficacies of alternative LN treatments. As more promising agents are entering the market, such as voclosporin, belimumab, and obinutuzumab, LN management might undergo significant changes during the next years.

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Section: Discussionmentioning

confidence: 99%

Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses

Smıth

Park

et al. 2022

JCM

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“… 71 Also, the PLUS (Plaquenil LUpus Systemic) failed to demonstrate that adjusted HCQ dosing schedules targeting [HCQ] ⩾1000 ng/ml might reduce the occurrence of SLE flares. 72 Most recently, Zanetti et al 73 tested the efficacy of lower HCQ doses (2–3 mg/kg/day) 30 and found similar 6- and 12-month flare rates between groups. 73 …”

Section: Efficacy In Systemic Lupus Erythematosusmentioning

confidence: 98%

“… 72 Most recently, Zanetti et al 73 tested the efficacy of lower HCQ doses (2–3 mg/kg/day) 30 and found similar 6- and 12-month flare rates between groups. 73 …”

Section: Efficacy In Systemic Lupus Erythematosusmentioning

confidence: 98%

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Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge

Dima

Jurcuţ²,

Chasset

et al. 2022

Therapeutic Advances in Musculoskeletal

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The antimalarial hydroxychloroquine (HCQ) has demonstrated several crucial properties for the treatment of systemic lupus erythematosus (SLE). Herein, we reviewed the main HCQ pharmacologic features, detailed its mechanism of action, and summarized the existing guidelines and recommendations for HCQ use in rheumatology with a systematic literature search for the randomized controlled trials focused on lupus. HCQ has been shown to decrease SLE activity, especially in mild and moderate disease, to prevent disease flare and to lower the long-term glucocorticoid need. The numerous benefits of HCQ are extended to pregnancy and breastfeeding period. Based on cohort studies, antithrombotic and metabolic HCQ’s effects were shown, including lipid-lowering properties, which might contribute to an improved cardiovascular risk. Moreover, early HCQ use in antinuclear antibodies positive individuals might delay the progression to SLE. Finally, HCQ has a significant favorable impact on long-term outcomes such as damage accrual and mortality in SLE. Based on these multiple benefits, HCQ is now the mainstay long-term treatment in SLE, recommended by current guidelines in all patients unless contraindications or side effects. The daily dose associated with the best compromise between efficacy and safety is matter of debate. The concern regarding retinal toxicity rather than proper efficacy data is the one that dictated the daily dosage of ⩽5 mg/kg/day actual body weight currently agreed upon.

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“…Administration of HCQ significantly reduces the severity of SLE disease activity, which includes a reduction in active clinical involvements, serum markers, activity scores, and disease flares [39]. Randomized controlled trials (RCT) have demonstrated the benefits of HCQ in SLE, including a reduction in flares [40][41][42], improvement in arthralgia [41], cytokine profiles [29,[43][44][45], and disease severity [36,[46][47][48][49]. HCQ decreases SLE disease activity, including flares during pregnancy [39,50].…”

Section: Hydroxychloroquinementioning

confidence: 99%

Recent Advances in SLE Treatment Including Biologic Therapies

Alenzi¹,

D’Cruz²

2023

Systemic Lupus Erythematosus - Pathogenesis and Management

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Systemic lupus erythematosus (SLE) is a long-term multisystem autoimmune rheumatic disease that can affect the skin, joints, kidneys, lungs, heart, and central nervous system. Clinical manifestations range from mild to severe and life-threatening diseases, which could be associated with poor outcomes, including morbidity, poor quality of life, and mortality. There is no cure for SLE, and the management is guided by organ system involvement, flare prevention, managing comorbidities, and reducing damage accumulation. Hydroxychloroquine is the most common drug that is used to control lupus disease activity. Anifrolumab is an antibody that inhibits all signaling through the type I interferon receptor and is licensed for the treatment of moderate to severe SLE. Voclosporin is a calcineurin inhibitor approved for the treatment of lupus nephritis. Belimumab as a biologic agent has been approved for the management of individuals with SLE and lupus nephritis. Despite the fact that rituximab has failed to meet its primary endpoints in clinical trials for SLE, rituximab can be used according to ACR and EULAR guidelines and is commonly used off-label for severe lupus flares. There is an unmet need for new biologic and novel therapeutic approaches in the management of SLE.

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Hydroxychloroquine blood levels in stable lupus nephritis under low dose (2–3 mg/kg/day): 12-month prospective randomized controlled trial

Cited by 9 publications

References 19 publications

Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses

Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses

Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge

Recent Advances in SLE Treatment Including Biologic Therapies

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