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Katarzyna PB, Wiktor S, Ewa D, Piotr L. Current treatment of systemic lupus erythematosus: a clinician's perspective. Rheumatol Int 2023:10.1007/s00296-023-05306-5. [PMID: 37171669 DOI: 10.1007/s00296-023-05306-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/04/2023] [Indexed: 05/13/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Its variable course makes it difficult to standardize patient treatment. This article aims at a literature review on available drugs for treating SLE and on drugs that have shown therapeutic effects in this disease. The PubMed/MEDLINE electronic search engine was used to identify relevant studies. This review presents the current therapeutic options, new biological therapies, and combination therapies of biologics with standard immunosuppressive and immunomodulating drugs. We have also underlined the importance to implement the treat-to-target strategy aimed at reducing or discontinuing therapy with glucocorticosteroids (GCs). The awareness of the benefits and risks of using GCs helps in refining their dosage and thereby obtaining a better safety profile. The advent of biological targeted therapies, and more recently, low-molecular-weight compounds such as kinase inhibitors, initiated numerous clinical trials in SLE patients and led to the approval of two biological drugs, belimumab, and anifrolumab, for SLE treatment. Progress in the treatment of SLE was reflected in the 2019 and 2021 recommendations of the European Alliance of Associations for Rheumatology (EULAR). However, a mass of recent clinical research data requires continuous consolidation to optimize patient outcomes.
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Affiliation(s)
- Pawlak-Buś Katarzyna
- Department of Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland.
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Struś Municipal Hospital, Poznań, Poland.
| | - Schmidt Wiktor
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Struś Municipal Hospital, Poznań, Poland
- Doctoral School, Poznań University of Medical Sciences, Poznań, Poland
| | - Dudziec Ewa
- Department of Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland
| | - Leszczyński Piotr
- Department of Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Struś Municipal Hospital, Poznań, Poland
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2
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Dima A, Jurcut C, Chasset F, Felten R, Arnaud L. Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge. Ther Adv Musculoskelet Dis 2022; 14:1759720X211073001. [PMID: 35186126 PMCID: PMC8848057 DOI: 10.1177/1759720x211073001] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/17/2021] [Indexed: 12/22/2022] Open
Abstract
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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Affiliation(s)
- Alina Dima
- Department of Rheumatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Ciprian Jurcut
- Department of Internal Medicine, Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - François Chasset
- Department of Dermatology and Allergology, Hôpital Tenon, Paris, France; Faculté de Médecine, Sorbonne Université, Paris, France
| | - Renaud Felten
- National Reference Center for Rare Auto-immune and Systemic Diseases Est Sud-Est (RESO), Strasbourg, France
- Department of Rheumatology, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- National Reference Center for Rare Auto-immune and Systemic Diseases Est Sud-Est (RESO), Strasbourg, France
- Department of Rheumatology, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Université de Strasbourg, Inserm UMR-S 1109, Strasbourg, France
- Service de Rhumatologie, Hôpital de Hautepierre, 1, avenue Molière BP 83049, 67098 Strasbourg Cedex, France
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3
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Costedoat‐Chalumeau N, Houssiau F, Izmirly P, Guern VL, Navarra S, Jolly M, Ruiz‐Irastorza G, Baron G, Hachulla E, Agmon‐Levin N, Shoenfeld Y, Dall'Ara F, Buyon J, Deligny C, Cervera R, Lazaro E, Bezanahary H, Leroux G, Morel N, Viallard J, Pineau C, Galicier L, Vollenhoven RV, Tincani A, Nguyen H, Gondran G, Zahr N, Pouchot J, Piette J, Petri M, Isenberg D. A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring
SLE
: Assessment by Drug Levels and Self‐Administered Questionnaires. Clin Pharmacol Ther 2018; 106:374-382. [DOI: 10.1002/cpt.1194] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Nathalie Costedoat‐Chalumeau
- Internal Medicine DepartmentCentre de Référence Maladies Auto‐Immunes et Systémiques RaresAP‐HPCochin Hospital Paris France
- Université Paris Descartes‐Sorbonne Paris Cité Paris France
- Center for Epidemiology and StatisticsINSERM U 1153Sorbonne Paris Cité (CRESS) Paris France
| | - Frédéric Houssiau
- Service de RhumatologieCliniques Universitaires Saint‐LucPôle de Pathologies Rhumatismales Inflammatoires et SystémiquesUniversité catholique de Louvain Brussels Belgium
| | - Peter Izmirly
- Division of RheumatologyDepartment of MedicineNew York University School of Medicine New York New York USA
| | - Véronique Le Guern
- Internal Medicine DepartmentCentre de Référence Maladies Auto‐Immunes et Systémiques RaresAP‐HPCochin Hospital Paris France
- Université Paris Descartes‐Sorbonne Paris Cité Paris France
- Center for Epidemiology and StatisticsINSERM U 1153Sorbonne Paris Cité (CRESS) Paris France
| | | | - Meenakshi Jolly
- Rush University Medical CenterRush Lupus Clinic Chicago Illinois USA
| | - Guillermo Ruiz‐Irastorza
- Autoimmune Diseases Research UnitDepartment of Internal MedicineBioCruces Health Research InstituteHospital Universitario CrucesUniversity of the Basque Country Barakaldo Spain
| | - Gabriel Baron
- Centre d'Epidémiologie CliniqueAP‐HPHôpitalHôtel‐DieuUniversité Paris Descartes‐Sorbonne Paris Cité Paris France
| | - Eric Hachulla
- Claude Huriez HospitalInternal Medicine DepartmentCentre de Référence Maladies Auto‐immunes et Systémiques raresUniversité de Lille Lille France
| | - Nancy Agmon‐Levin
- Sheba Medical CenterZabludowicz Center for Autoimmune Diseases Tel‐Hashomer Israel
| | - Yehuda Shoenfeld
- Sheba Medical CenterZabludowicz Center for Autoimmune Diseases Tel‐Hashomer Israel
| | - Francesca Dall'Ara
- Rheumatology and Clinical Immunology UnitSpedali Civili and Department of Clinical and Experimental ScienceUniversity of Brescia Brescia Italy
| | - Jill Buyon
- Division of RheumatologyDepartment of MedicineNew York University School of Medicine New York New York USA
| | - Christophe Deligny
- Internal Medicine DepartmentPierre‐Zobda‐Quitman Hospital Martinique France
| | - Ricard Cervera
- Department of Autoimmune DiseasesHospital Clínic de Barcelona Barcelona Spain
| | | | - Holy Bezanahary
- Internal Medicine DepartmentDupuytren Hospital Limoges France
| | - Gaëlle Leroux
- Internal Medicine DepartmentAP‐HPPitié‐Salpêtrière HospitalUniversité Pierre et Marie Curie Paris France
| | - Nathalie Morel
- Internal Medicine DepartmentCentre de Référence Maladies Auto‐Immunes et Systémiques RaresAP‐HPCochin Hospital Paris France
- Université Paris Descartes‐Sorbonne Paris Cité Paris France
- Center for Epidemiology and StatisticsINSERM U 1153Sorbonne Paris Cité (CRESS) Paris France
| | | | | | - Lionel Galicier
- Clinical Immunology DepartmentAP‐HPSt Louis Hospital Paris France
| | - Ronald Van Vollenhoven
- Department of MedicineUnit for Clinical Research TherapyInflammatory DiseasesKarolinska University Hospital Stockholm Sweden
| | - Angela Tincani
- Rheumatology and Clinical Immunology UnitSpedali Civili and Department of Clinical and Experimental ScienceUniversity of Brescia Brescia Italy
| | - Hanh Nguyen
- Centre for RheumatologyUniversity College London London UK
| | | | - Noel Zahr
- Pharmacology DepartmentAP‐HPHopital Pitié‐Salpêtrière Paris France
| | - Jacques Pouchot
- Internal Medicine DepartmentEuropean Georges Pompidou Hospital Paris France
| | - Jean‐Charles Piette
- Internal Medicine DepartmentAP‐HPPitié‐Salpêtrière HospitalUniversité Pierre et Marie Curie Paris France
| | - Michelle Petri
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - David Isenberg
- Centre for RheumatologyUniversity College London London UK
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Costedoat-Chalumeau N, Houssiau F, Izmirly P, Le Guern V, Navarra S, Jolly M, Ruiz-Irastorza G, Baron G, Hachulla E, Agmon-Levin N, Shoenfeld Y, Dall'Ara F, Buyon J, Deligny C, Cervera R, Lazaro E, Bezanahary H, Leroux G, Morel N, Viallard JF, Pineau C, Galicier L, Van Vollenhoven R, Tincani A, Nguyen H, Gondran G, Zahr N, Pouchot J, Piette JC, Petri M, Isenberg D. A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self-Administered Questionnaires. Clin Pharmacol Ther 2017; 103:1074-1082. [PMID: 28925027 DOI: 10.1002/cpt.885] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 01/24/2023]
Abstract
Nonadherence to treatment is a major cause of lupus flares. Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half-life and can be quantified by high-performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ <200 ng/ml or undetectable desethylchloroquine), and self-administered questionnaires (MASRI <80% or MMAS-8 <6). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level. Questionnaires classified 39.9% of patients as nonadherent. Correlations between adherence measured by questionnaires, drug level, and physician assessment were moderate. Both methods probably measured two different patterns of nonadherence: self-administered questionnaires mostly captured relatively infrequently missed tablets, while drug levels identified severe nonadherence (i.e., interruption or erratic tablet intake). The frequency with which physicians miss nonadherence, together with underreporting by patients, suggests that therapeutic drug monitoring is useful in this setting. (Trial registration: ClinicalTrials.gov: NCT01509989.).
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Affiliation(s)
- Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Frédéric Houssiau
- Service de Rhumatologie, Cliniques Universitaires Saint-Luc; Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Université catholique de Louvain, Brussels, Belgium
| | - Peter Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | | | - Meenakshi Jolly
- Rush University Medical Center, Rush Lupus Clinic, Chicago, Illinois, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Gabriel Baron
- AP-HP, Hôpital Hôtel-Dieu, Centre d'Epidémiologie Clinique, Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Eric Hachulla
- Claude Huriez Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques rares, Université de Lille, Lille, France
| | - Nancy Agmon-Levin
- Sheba Medical Center, Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel
| | - Yehuda Shoenfeld
- Sheba Medical Center, Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel
| | - Francesca Dall'Ara
- Rheumatology and Clinical Immunology Unit, Spedali Civili and Dept. of Clinical and Experimental Science-University of Brescia, Italy
| | - Jill Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Christophe Deligny
- Pierre-Zobda-Quitman Hospital, Internal Medicine Department, Martinique, France
| | - Ricard Cervera
- Hospital Clínic de Barcelona, Department of Autoimmune Diseases, Barcelona, Spain
| | - Estibaliz Lazaro
- Haut Lévêque Hospital, Internal Medicine Department, Pessac, France
| | - Holy Bezanahary
- Dupuytren Hospital, Internal Medicine Department, Limoges, France
| | - Gaëlle Leroux
- AP-HP, Pitié-Salpêtrière Hospital, Internal Medicine Department, Université Pierre et Marie Curie, Paris, France
| | - Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | | | | | - Lionel Galicier
- AP-HP, St Louis Hospital, Clinical Immunology Department, Paris, France
| | - Ronald Van Vollenhoven
- Karolinska University Hospital, Department of Medicine, Unit for Clinical Research Therapy, Inflammatory Diseases, Stockholm, Sweden
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Spedali Civili and Dept. of Clinical and Experimental Science-University of Brescia, Italy
| | - Hanh Nguyen
- University College London, Centre for Rheumatology, London, UK
| | | | - Noel Zahr
- AP-HP, Hopital Pitié-Salpêtrière, Pharmacology Department, Paris, France
| | - Jacques Pouchot
- European Georges Pompidou Hospital, Internal Medicine Department, Paris, France
| | - Jean-Charles Piette
- AP-HP, Pitié-Salpêtrière Hospital, Internal Medicine Department, Université Pierre et Marie Curie, Paris, France
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Isenberg
- University College London, Centre for Rheumatology, London, UK
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5
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Wu SF, Chang CB, Hsu JM, Lu MC, Lai NS, Li C, Tung CH. Hydroxychloroquine inhibits CD154 expression in CD4 + T lymphocytes of systemic lupus erythematosus through NFAT, but not STAT5, signaling. Arthritis Res Ther 2017; 19:183. [PMID: 28793932 PMCID: PMC5550984 DOI: 10.1186/s13075-017-1393-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/18/2017] [Indexed: 12/28/2022] Open
Abstract
Background Overexpression of membranous CD154 in T lymphocytes has been found previously in systemic lupus erythematosus (SLE). Because hydroxychloroquine (HCQ) has been used frequently in the treatment of lupus, we sought to identify the effects of HCQ on CD154 and a possibly regulatory mechanism. Methods CD4+ T cells were isolated from the blood of lupus patients. After stimulation with ionomycin or IL-15 and various concentrations of HCQ, expression of membranous CD154 and NFAT and STAT5 signaling were assessed. Results HCQ treatment had significant dose-dependent suppressive effects on membranous CD154 expression in ionomycin-activated T cells from lupus patients. Furthermore, HCQ inhibited intracellular sustained calcium storage release, and attenuated the nuclear translocation of NFATc2 and the expression of NFATc1. However, CD154 expressed through IL-15-mediated STAT5 signaling was not inhibited by HCQ treatment. Conclusions HCQ inhibited NFAT signaling in activated T cells and blocked the expression of membranous CD154, but not STAT5 signaling. These findings provide a mechanistic insight into SLE in HCQ treatment.
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Affiliation(s)
- Shu-Fen Wu
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan
| | - Chia-Bin Chang
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan
| | - Jui-Mei Hsu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.,Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi, Taiwan
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi, Taiwan
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi, Taiwan
| | - Chin Li
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan
| | - Chien-Hsueh Tung
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan. .,Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
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Yeon Lee J, Lee J, Ki Kwok S, Hyeon Ju J, Su Park K, Park SH. Factors Related to Blood Hydroxychloroquine Concentration in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2017; 69:536-542. [PMID: 27390146 DOI: 10.1002/acr.22962] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/04/2016] [Accepted: 06/21/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To identify factors associated with blood concentrations of hydroxychloroquine (HCQ) and its major metabolite, N-desethylhydroxychloroquine (DHCQ), in patients with systemic lupus erythematosus (SLE; lupus) receiving long-term oral HCQ treatment. METHODS SLE patients who had been taking HCQ for more than 3 months were recruited. Various clinical characteristics, laboratory values, and SLE Disease Activity Index (SLEDAI) scores were examined. The concentrations of HCQ and DHCQ ([HCQ] and [DHCQ]) were measured by liquid chromatography mass spectrometry, and the relationship between [HCQ], [DHCQ], and [HCQ]:[DHCQ] ratio to various factors was investigated. RESULTS In total, 189 SLE patients receiving long-term HCQ treatment were included in the analysis. The median (interquartile range [IQR]) [HCQ] was 515 (IQR 353-720) ng/ml, the median [DHCQ] was 417 (IQR 266-591) ng/ml, and the median [HCQ]:[DHCQ] ratio was 1.3 (range 1.0-1.7). [HCQ] was closely associated with [DHCQ] (r = 0.81, P < 0.0001). The weight-adjusted oral HCQ dose was strongly associated with both [HCQ] (P < 0.001) and [DHCQ] (P < 0.001). Time since last dose was associated with [HCQ] (P < 0.001). No statistically significant association was found between renal function or smoking and [HCQ] or [DHCQ]. Use of additional immunosuppressants increased both [HCQ] and [DHCQ] after adjusting for possible confounders (P = 0.04 and P = 0.03, respectively). The lower SLEDAI score was significantly related to higher [HCQ], after adjusting for age, sex, weight-adjusted HCQ dose, time since last dose, number of other immunosuppressants, and smoking status (P = 0.007). CONCLUSION Various factors affected blood levels of [HCQ], [DHCQ], or the [HCQ]:[DHCQ] ratio of SLE patients receiving long-term oral HCQ treatment. Notably, higher [HCQ] was associated with a lower SLEDAI score in our typical outpatient clinic population with lupus.
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Affiliation(s)
- Ji Yeon Lee
- Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Jennifer Lee
- Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Seung Ki Kwok
- Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Ji Hyeon Ju
- Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Kyung Su Park
- Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Sung-Hwan Park
- Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
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Costedoat-Chalumeau N, Tamirou F, Le Guern V, Blanchet B, Deligny C, Piette JC. Dosage sanguin de l’hydroxychloroquine dans la prise en charge du lupus systémique : intérêts et limites. Rev Med Interne 2017; 38:77-80. [DOI: 10.1016/j.revmed.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022]
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8
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Lee JY, Vinayagamoorthy N, Han K, Kwok SK, Ju JH, Park KS, Jung SH, Park SW, Chung YJ, Park SH. Association of Polymorphisms of Cytochrome P450 2D6 With Blood Hydroxychloroquine Levels in Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol 2016; 68:184-90. [PMID: 26316040 DOI: 10.1002/art.39402] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/18/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate associations of genetic polymorphisms in cytochrome P450 (CYP) isoforms 2D6, 3A5, and 3A4 with blood concentrations of hydroxychloroquine (HCQ) and its metabolite, N-desethyl HCQ (DHCQ), in patients with systemic lupus erythematosus (SLE). METHODS SLE patients taking HCQ for >3 months were recruited and were genotyped for 4 single-nucleotide polymorphisms in CYP2D6*10, CYP3A5*3, and CYP3A4*18B. Blood HCQ and DHCQ concentrations ([HCQ] and [DHCQ]) were measured and their association with corresponding genotypes was investigated. RESULTS A total of 194 patients were included in the analysis. CYP2D6*10 polymorphisms (rs1065852 and rs1135840) were significantly associated with the [DHCQ]:[HCQ] ratio after adjustment for age, sex, dose per weight per day, and SLE Disease Activity Index score (P = 0.03 and P < 0.01, respectively). In adjusted models, the [DHCQ]:[HCQ] ratio was highest in patients with the G/G genotype of the CYP2D6*10 (rs1065852) polymorphism and lowest in those with the A/A genotype (P = 0.03). Similarly, the [DHCQ]:[HCQ] ratio was highest in patients with the C/C genotype of the CYP2D6*10 (rs1135840) polymorphism and lowest in those with the G/G genotype (P < 0.01). The CYP2D6*10 (rs1065852) polymorphism was significantly related to the [DHCQ] (P = 0.01). However, the polymorphisms of CYP3A5*3 and CYP3A4*18B did not show any significant association with the [HCQ], [DHCQ], or [DHCQ]:[HCQ] ratio. CONCLUSION Our study showed that the [DHCQ]:[HCQ] ratio was related to CYP2D6 polymorphisms in Korean lupus patients taking oral HCQ. CYP polymorphisms may explain why there is wide variation in blood HCQ concentrations. The role of an individual's CYP polymorphisms should be considered when prescribing oral HCQ.
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Affiliation(s)
- Ji Yeon Lee
- Catholic University of Korea and Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | | | - Kyungdo Han
- Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Ki Kwok
- Catholic University of Korea and Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Ji Hyeon Ju
- Catholic University of Korea and Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Kyung Su Park
- Catholic University of Korea and Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | | | - Sung-Won Park
- Catholic University of Korea, Seoul, Republic of Korea
| | | | - Sung-Hwan Park
- Catholic University of Korea and Seoul St. Mary's Hospital, Seoul, Republic of Korea
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9
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Chasset F, Arnaud L, Costedoat-Chalumeau N, Zahr N, Bessis D, Francès C. The effect of increasing the dose of hydroxychloroquine (HCQ) in patients with refractory cutaneous lupus erythematosus (CLE): An open-label prospective pilot study. J Am Acad Dermatol 2016; 74:693-9.e3. [DOI: 10.1016/j.jaad.2015.09.064] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/23/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
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10
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Hosokawa K, Muranski P, Feng X, Townsley DM, Liu B, Knickelbein J, Keyvanfar K, Dumitriu B, Ito S, Kajigaya S, Taylor JG, Kaplan MJ, Nussenblatt RB, Barrett AJ, O'Shea J, Young NS. Memory Stem T Cells in Autoimmune Disease: High Frequency of Circulating CD8+ Memory Stem Cells in Acquired Aplastic Anemia. THE JOURNAL OF IMMUNOLOGY 2016; 196:1568-78. [PMID: 26764034 DOI: 10.4049/jimmunol.1501739] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/08/2015] [Indexed: 11/19/2022]
Abstract
Memory stem T cells (TSCMs) constitute a long-lived, self-renewing lymphocyte population essential for the maintenance of functional immunity. Hallmarks of autoimmune disease pathogenesis are abnormal CD4(+) and CD8(+) T cell activation. We investigated the TSCM subset in 55, 34, 43, and 5 patients with acquired aplastic anemia (AA), autoimmune uveitis, systemic lupus erythematosus, and sickle cell disease, respectively, as well as in 41 age-matched healthy controls. CD8(+) TSCM frequency was significantly increased in AA compared with healthy controls. An increased CD8(+) TSCM frequency at diagnosis was associated with responsiveness to immunosuppressive therapy, and an elevated CD8(+) TSCM population after immunosuppressive therapy correlated with treatment failure or relapse in AA patients. IFN-γ and IL-2 production was significantly increased in various CD8(+) and CD4(+) T cell subsets in AA patients, including CD8(+) and CD4(+) TSCMs. CD8(+) TSCM frequency was also increased in patients with autoimmune uveitis or sickle cell disease. A positive correlation between CD4(+) and CD8(+) TSCM frequencies was found in AA, autoimmune uveitis, and systemic lupus erythematosus. Evaluation of PD-1, CD160, and CD244 expression revealed that TSCMs were less exhausted compared with other types of memory T cells. Our results suggest that the CD8(+) TSCM subset is a novel biomarker and a potential therapeutic target for AA.
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Affiliation(s)
- Kohei Hosokawa
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892;
| | - Pawel Muranski
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Xingmin Feng
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Danielle M Townsley
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Baoying Liu
- Clinical Immunology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Jared Knickelbein
- Clinical Immunology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Keyvan Keyvanfar
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Bogdan Dumitriu
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Sawa Ito
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Sachiko Kajigaya
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - James G Taylor
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892; and
| | - Robert B Nussenblatt
- Clinical Immunology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - A John Barrett
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - John O'Shea
- Molecular Immunology and Inflammation Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
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Determinants of medication non-adherence in Egyptian patients with systemic lupus erythematosus: Sharkia Governorate. Rheumatol Int 2014; 35:1045-51. [PMID: 25424491 DOI: 10.1007/s00296-014-3182-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 11/17/2014] [Indexed: 12/16/2022]
Abstract
The aim of the study was to identify the determinants of adherence to medication among Egyptian patients with SLE. A single-center cross-sectional study was conducted among Egyptian patients with SLE. Adherence to medication was measured via The Compliance Questionnaire for Rheumatology-19, and the patients were classified as non-adherers if they were taking <80% of their medication correctly. Predictors of adherence to SLE medication were determined by multiple logistic regressions. The mean age of participants was 30.9 ± 11.7 years. Females constituted 95% of all participants. Thirty-eight (%) were taking <80% of their medication correctly. On logistic regression analysis, the significant independent predictors of medication non-adherence were lower educational level (OR 5.6, 95% CI 2.1-7.3, P < 0.001), very low and low socioeconomic status (OR 2.6, 95% CI 1.6-4.3, P < 0.04), rural residency (OR 3.4, 95% CI 1.4-5, P < 0.01), more number of medications (OR 3.2, 95% CI 2.3-6.9, P < 0.01), and higher depressive symptoms (OR 3.7, 95% CI 1.4-10.2, P < 0.001). The adherence rate reported in this study was quite low. Appropriate adherence enhancing intervention strategies targeted at reducing pill load, minimizing depressive symptoms, and ensuring an uninterrupted access to free services regimen for patients with low socioeconomic status is strongly recommended. More attention should be given to SLE patients who live in rural regions.
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12
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13
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Carmichael SJ, Day RO, Tett SE. A cross-sectional study of hydroxychloroquine concentrations and effects in people with systemic lupus erythematosus. Intern Med J 2013; 43:547-53. [DOI: 10.1111/imj.12100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 02/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- S. J. Carmichael
- School of Pharmacy; University of Queensland; Brisbane Queensland Australia
| | - R. O. Day
- Clinical Pharmacology; St Vincent's Hospital; Sydney New South Wales Australia
- Department of Physiology and Pharmacology; University of New South Wales; Sydney New South Wales Australia
| | - S. E. Tett
- School of Pharmacy; University of Queensland; Brisbane Queensland Australia
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14
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Marengo MF, Waimann CA, Achaval SD, Zhang H, Garcia-Gonzalez A, Richardson MN, Reveille JD, Suarez-Almazor ME. Measuring therapeutic adherence in systemic lupus erythematosus with electronic monitoring. Lupus 2012; 21:1158-65. [DOI: 10.1177/0961203312447868] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: We used an electronic monitoring system to quantify adherence to prescribed oral therapies by patients with systemic lupus erythematosus (SLE). Methods: Participants were included from a larger longitudinal study cohort of 110 patients recruited from publicly-funded rheumatology clinics, 78 of whom agreed to have their SLE drug therapy electronically monitored for two years with the Medication Events Monitoring System (MEMS®, AARDEX Group). Adherence was determined as the percentage of days (weeks for methotrexate) the patient took the medication as prescribed by the physician. Collected data included SLEDAI; SLICC damage index for SLE (SDI); medical outcome study social support survey (MOS-SSS); Center for Epidemiologic Studies depression scale (CESD); and quality of life (SF-12). Results: Ninety percent of the cohort was female, 45% were Hispanic, and 49% were African-American. Mean age was 36.3 years, disease duration was 5.9 years, SLEDAI score was 3.2, and SDI score was 0.9. Adherence was 62% for all drugs combined and did not differ significantly for individual medications. Patients with more depression ( p < 0.02), and higher number of pills taken daily ( p < 0.02) were more likely to be non-adherent. Only one-fourth of the patients had an average adherence of ≥80%; these patients had a better mental component score (SF-12) at 24 months than non-adherent patients ( p < 0.01). Conclusions: Electronic monitoring demonstrated that only one-fourth of the patients had an adherence rate ≥80%. Polypharmacy and depression were associated with non-adherence.
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Affiliation(s)
- MF Marengo
- The University of Texas MD Anderson Cancer Center, USA
| | - CA Waimann
- The University of Texas MD Anderson Cancer Center, USA
| | - S de Achaval
- The University of Texas MD Anderson Cancer Center, USA
| | - H Zhang
- The University of Texas MD Anderson Cancer Center, USA
| | | | - MN Richardson
- The University of Texas MD Anderson Cancer Center, USA
| | - JD Reveille
- The University of Texas Medical School at Houston, USA
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15
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de Achaval S, Suarez-Almazor ME. Treatment adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis and systemic lupus erythematosus. INTERNATIONAL JOURNAL OF CLINICAL RHEUMATOLOGY 2010; 5:313-326. [PMID: 20676388 PMCID: PMC2910438 DOI: 10.2217/ijr.10.15] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Treatment adherence is critical in the management of rheumatic diseases. Recent advances in therapy for rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are promising, although the impact on quality of life may be limited due to nonadherence. Databases including Ovid Medline, Scopus and the Epub-ahead-of-print subset of PubMed were searched for the period of the last 10 years using combined keywords patient compliance, medication adherence, disease modifying antirheumatic drug (DMARD), rheumatoid arthritis and systemic lupus erythematosus. Additional references from retrieved papers were considered. Inclusion criteria were the following: identification of a quantitative measure of adherence to medications including DMARDs and biologics; inclusion of well-defined measures of adherence; and patients with RA or SLE. Studies in RA and SLE patients demonstrated overall inadequate treatment adherence. Adherence was measured using multiple methods including pharmacy records, electronic monitoring, self-report and physician report. The evidence for interventions to improve treatment adherence was limited and demonstrated various results. Future research should further explore determinants of nonadherence and continue to examine the efficacy of implementing various strategies to improve medication management in this patient population.
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Affiliation(s)
- Sofia de Achaval
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Banica L, Besliu A, Pistol G, Stavaru C, Ionescu R, Forsea AM, Tanaseanu C, Dumitrache S, Otelea D, Tamsulea I, Tanaseanu S, Chitonu C, Paraschiv S, Balteanu M, Stefanescu M, Matache C. Quantification and molecular characterization of regulatory T cells in connective tissue diseases. Autoimmunity 2009; 42:41-9. [PMID: 18800250 DOI: 10.1080/08916930802282651] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of our study was to investigate and characterize regulatory T cells (Treg) in peripheral blood of patients with connective tissue diseases (Systemic lupus erythematosus, systemic sclerosis, Sjögren's syndrome, poly- and dermatomyositis) as compared with blood from healthy controls. Treg cells were quantified and phenotypically characterized by flow cytometry while the expression level of Foxp3 mRNA was evaluated by real time PCR. A reduced percentage of peripheral blood Treg cells was found in patients than in controls, irrespective of the type of connective tissue disease. Treg cells, especially those expressing one of the phenotypical markers, seemed to differ not only between patients and healthy controls but also among types of diseases. Additionally, the presence of autoantibodies as well as disease activity appeared to be correlated with particular Treg cell populations, especially those expressing one of the examined phenotypical markers. Correlations with therapy suggested that glucocorticoids plus antimalarial or other immunosuppressor drugs diminished the percentage of Treg cells, especially of those with memory phenotype. These findings indicated dysregulations at the level of Treg cells and suggested an involvement of these cells in the pathology of connective tissue diseases. Moreover, our data are in agreement with the suggestion that Treg cells could be therapeutic targets for some autoimmune diseases.
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Affiliation(s)
- Leontina Banica
- Cellular Receptors Laboratory, Cantacuzino National Institute of Research and Development for Microbiology and Immunology, Centre for Advanced Studies, Bucharest, Romania
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