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Area of Science:

  • Rheumatology
  • Clinical Pharmacology

Background:

  • Systemic lupus erythematosus (SLE) is a chronic autoimmune disease requiring long-term management.
  • Antimalarials, especially hydroxychloroquine (HCQ), are a cornerstone therapy for SLE.
  • Optimizing antimalarial use is essential for improving patient outcomes and reducing healthcare burden.

Purpose of the Study:

  • To review the latest evidence on the clinical efficacy and toxicity of antimalarials in SLE patients.
  • To highlight the benefits of HCQ in preventing SLE flares, damage, and infections.
  • To address challenges in HCQ prescription and patient adherence.

Main Methods:

  • Systematic review of recent clinical studies and data.
  • Analysis of efficacy, safety profiles, and resource utilization associated with antimalarials.
  • Evaluation of specific toxicities and protective effects of HCQ.

Main Results:

  • Antimalarials, including HCQ, effectively reduce SLE activity, organ damage, infections, and mortality.
  • Continued HCQ use is linked to decreased healthcare resource utilization.
  • HCQ demonstrates a favorable safety profile with infrequent serious toxicities; ocular toxicity is rare and linked to blood levels.
  • Low doses (200 mg/day) of HCQ offer a good efficacy/toxicity balance.
  • HCQ provides protection against herpes zoster and Pneumocystis jirovecii infections.
  • Despite benefits, HCQ prescription and patient adherence are below recommended levels.
  • The COVID-19 pandemic caused HCQ shortages, impacting lupus patient treatment.

Conclusions:

  • Hydroxychloroquine (HCQ) remains central to SLE management, with consistent benefits across diverse populations.
  • Efforts should focus on ensuring appropriate HCQ prescription and preventing unnecessary drug discontinuation.
  • Addressing underrecognized toxicities and improving patient adherence are critical for maximizing HCQ's therapeutic potential in SLE.