Lupus: Predictors of Poor Outcomes Following Hydroxychloroquine Tapering, Discontinuation Are Identified

Certain demographic and clinical factors are linked with poor outcomes following hydroxychloroquine (HCQ) tapering or discontinuation, according to findings of a new study.

“HCQ is a key systemic lupus drug, making concerns of drug shortages grave,” the researchers wrote.

The researchers analyzed data on 398 patients who had tapered HCQ, 395 patients who had discontinued HCQ, and 395 patients who remained on HCQ between 1999 and 2019 in Canada. A subsequent need for therapy augmentation, an increase of at least 4 points in Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), or hospitalization for systemic lupus erythematosus were outcomes of interest. 

Per 100 person-years, the poor outcome rate was 35.7 in the HCQ taper cohort, 29 in the discontinuation cohort, and 16.1 in the maintenance cohort, according to the study. 

Baseline prednisone use was independently associated with greater risk of poor outcomes among patients tapering HCQ, the researchers reported. For patients discontinuing the drug, poor outcomes were more likely among patients who were Black and patients diagnosed with lupus before aged 25 years or younger. Among patients who remained on HCQ, use of immunosuppressive drugs at baseline and First Nation ethnicity were linked with poor outcomes.

“This information is critical in the current setting of potential shortages, but long-term, this could inform personalized therapies,” the researchers wrote.

—Jolynn Tumolo

Reference:

Almeida-Brasil CC, Pineau CA, Vinet E, et al. Predictors of unsuccessful hydroxychloroquine tapering and discontinuation: can we personalize decision-making in systemic lupus treatment? Arthritis Care Res. Published online December 26, 2020. doi:10.1002/acr.24548