Rheumatology ·
Large hydroxychloroquine reductions linked to flare risk in quiescent lupus
A retrospective cohort study of 381 patients with clinically quiescent systemic lupus erythematosus found that stopping hydroxychloroquine or reducing its dose by at least 75% was associated with increased flare risk. Smaller reductions were not associated with higher risk in the study; the proposed reduction threshold had weak discriminatory performance.
- Retrospective cohort included 381 patients in clinical remission.
- 52.5% experienced a flare during median 1.38-year follow-up.
- Stopping or reducing HCQ by ≥75% was associated with flares.
- Exploratory 74.7% threshold had an AUC of 0.55.
Researchers retrospectively followed 381 patients with systemic lupus erythematosus in clinical remission (clinical SLEDAI-2K score of 0, prednisolone dose ≤5 mg/day) who were taking hydroxychloroquine. The primary outcome was flare, defined as a rise of at least one point in clinical SLEDAI-2K or treatment escalation. Median follow-up was 1.38 years.
Overall, 52.5% of patients developed a flare. Hydroxychloroquine discontinuation was associated with increased flare risk (adjusted hazard ratio [aHR] 1.80, 95% CI 1.17–2.75; adjusted odds ratio [aOR] 5.60, 95% CI 2.47–12.71). A dose reduction of at least 75% was also associated with increased risk (aHR 1.53, 95% CI 1.02–2.30; aOR 4.40, 95% CI 2.17–8.92); lesser reductions were not. The exploratory receiver operating characteristic threshold was a 74.7% reduction, but its area under the curve was 0.55.
The findings associate discontinuation and substantial dose reduction with flares, but the retrospective design cannot establish causation. The low AUC also indicates limited ability of the proposed threshold to distinguish patients who will flare. The results do not establish an optimal tapering strategy.
In practice
For patients with clinically quiescent systemic lupus erythematosus taking hydroxychloroquine, this retrospective cohort found that discontinuation and reductions of at least 75% were associated with increased flare risk; lesser reductions were not. These findings support caution around marked dose reduction but do not establish that reduction causes flares or define an optimal taper. The proposed 74.7% threshold was exploratory and had weak discrimination (AUC 0.55), so it should not be treated as a validated decision threshold.
AI-generated clinical interpretation · Not editor-reviewed
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Arthritis Care & Research: Threshold of Hydroxychloroquine Dose Reduction Associated with Flare in Quiescent Systemic Lupus Erythematosus ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.