Treatment effectiveness of hydroxychloroquine in patients with primary Sjögren's syndrome: a real-world Study

This study aimed to evaluate the effectiveness of hydroxychloroquine (HCQ) in reducing disease activity and explore its optimal dosing and combination therapies in patients with primary Sjögren's syndrome (pSS).

We conducted a retrospective study of 1089 hospitalized pSS patients. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Propensity score matching (PSM) was performed to assess robustness.

Compared to non-users, patients receiving HCQ at daily doses of 300 mg (OR = 2.50, 95% CI 1.08-5.77), 400 mg (OR = 1.66, 95% CI 1.21-2.27), or > 5 mg/kg (OR = 1.71, 95% CI 1.25-2.34) showed higher response rates. Subgroup analyses suggested greater HCQ effectiveness in patients aged ≤ 50 years, without hypertension or diabetes, with SSA/RF seropositivity, no prior HCQ exposure, baseline ESSDAI scores of 5-13, concomitant glucocorticoids (GCs) use (> 20 mg/day), normal C3 level, or low C4 levels. The combination of GCs, cyclosporin A, and HCQ demonstrated a numerically higher response rate than GCs plus cyclosporin A alone (OR = 3.73, 95% CI 1.19-11.72). HCQ was associated with improved outcomes in thrombocytopenia (OR = 1.81, 95% CI 1.01-3.25), hypoalbuminemia (OR = 1.72, 95% CI 1.24-2.38), and elevated erythrocyte sedimentation rate (ESR) (OR = 2.25, 95% CI 1.42-3.58).

HCQ at daily doses of 300 mg, 400 mg, or > 5 mg/kg may reduce disease activity in pSS patients, particularly in specific subgroups. The combination of GCs, cyclosporin A, and HCQ warrants further investigation as a potential therapeutic strategy. HCQ might also benefit patients with thrombocytopenia, hypoalbuminemia, or elevated ESR. Key Points • A daily HCQ dosage of 300 mg, 400 mg or >5 mg/kg effectively reduced disease activity in pSS patients. • HCQ demonstrated therapeutic efficacy in specific pSS patient subgroups. • Glucocorticoids, cyclosporin A and HCQ may be a promising drug combination.