Hydroxychloroquine is a good second‐line treatment for adults with immune thrombocytopenia and positive antinuclear antibodies

Abstract

Treatment of patients with lupus-associated thrombocytopenia (SLE-ITP) is not standardized. We report data on efficacy and safety of hydroxychloroquine (HCQ) in this setting and in ITP patients with positive antinuclear antibodies (ANA) without definite SLE. Inclusion criteria were: definite diagnosis of ITP with a platelet count (PLT) <50 3 10 9 /L, ANA 1/160 on Hep2 cells with or without a definite diagnosis of SLE, and no sustained response to at least one previous treatment-line and treatment with HCQ. Response criteria were Complete Response (CR) for PLT 100 3 10 9 /L and Response (R) for PLT 30 3 10 9 /L and at least twice the initial value. Forty patients (32 females) with a mean age of 35 6 17 years and PLT at ITP diagnosis of 14 6 13 3 10 9 /L were analyzed. Twelve (30%) patients had a SLE-ITP, 28 patients had only positive ANA. All the patients failed to respond to oral prednisone with a median of two treatment-lines (1-5) before HCQ which was initially given in combination with another ITP treatment in 36 patients. Overall response rate was 60% (24/40) including 18 lasting CR and six lasting R maintained with a median follow-up of 64 months (6-146), in 3 =4 of cases with only HCQ and no concomitant ITP treatment. The response rate (CR1R) was higher in the SLE group vs ANApositive group (83% vs 50%, P < 0.05). No patient stopped HCQ because of a side-effect. HCQ appears to be a safe and effective second line treatment for patients with SLE-ITP or ITP and high titer of ANA. This trial was registered at www.clinicaltrials.gov as # NCT01549184.

Is there still a place for “old therapies” in the management of immune thrombocytopenia?

“…More recently, the usefulness of HCQ has been reported in primary ITP with biological markers of lupus [57]. Forty patients, mean age of 35 years, suffering from ITP with positive antinuclear antibodies (ANA, level > 1/160, median level: 1/1280), among whom 30% were affected by lupus according to the American College of Rheumatology criteria, were treated with HCQ 200 mg twice a day (83%).…”

Evaluation of the efficiency of hydroxychloroquine in treating children with immune thrombocytopenia (ITP)

“…Hydroxychloroquine (Plaquenil®) is an antimalarial drug with inflammatory properties. Godeau's team 5 criteria. 6 We also noted the presence of adverse effects associated with hydroxychloroquine.…”

“…The median initial dose of treatment was 6.2 mg/kg/ day [3.1-9.2]. The median Buchanan score at the time of introduction of hydroxychloroquine was 1 [0-1].The median platelet level was 7 G/L[4][5][6][7][8][9][10][11] at diagnosis, 7 G/L[4- 11] at the time of introduction of hydroxychloroquine, 59 G/L at six months and 92 G/L [29-165] at twelve months from the beginning of treatment (Figure 1). 95.7% were screened for ANF and 54.5% were positive.…”

Purpura thrombopénique immunologique et grossesse : état des connaissances actuelles et questions encore sans réponse

“…L'hydroxychloroquine est utile au cours des PTI associés à un authentique lupus ou associés à la présence d'anticorps antinucléaires positifs [28]. Son efficacité est cependant retardée avec un délai d'action de plusieurs mois, malheureusement trop prolongé pour que cette thérapeutique soit réellement utile dans la situation spécifique de la grossesse.…”