Hydroxychloroquine levels in patients with systemic lupus erythematosus: whole blood is preferable but serum levels also detect non-adherence
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Published:2020-09-25
Issue:1
Volume:22
Page:
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ISSN:1478-6362
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Container-title:Arthritis Research & Therapy
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language:en
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Short-container-title:Arthritis Res Ther
Author:
Blanchet Benoit, Jallouli Moez, Allard Marie, Ghillani-Dalbin Pascale, Galicier Lionel, Aumaître Olivier, Chasset François, Le Guern Véronique, Lioté Frédéric, Smail Amar, Limal Nicolas, Perard Laurent, Desmurs-Clavel Hélène, Le Thi Huong Du, Asli Bouchra, Kahn Jean-Emmanuel, Sailler Laurent, Ackermann Félix, Papo Thomas, Sacré Karim, Fain Olivier, Stirnemann Jérôme, Cacoub Patrice, Leroux Gaelle, Cohen-Bittan Judith, Sellam Jérémie, Mariette Xavier, Goulvestre Claire, Hulot Jean Sébastien, Amoura Zahir, Vidal Michel, Piette Jean-Charles, Astudillo Leonardo, Belizna Cristina, Belmatoug Nadia, Benveniste Olivier, Benyamine Audrey, Bezanahary Holly, Blanco Patrick, Bodaghi Bahram, Bourgeois Pierre, Brihaye Benoît, Chatelus Emmanuel, Damade Richard, Daugas Eric, De Gennes Christian, Delfraissy Jean-François, Delluc Céline, Delluc Aurélien, Duhaut Pierre, Dupuy Alain, Durieu Isabelle, Ea Hang Korng, Farge Dominique, Funck-Brentano Christian, Gandjbakhch Frédérique, Gellen-Dautremer Justine, Godeau Bertrand, Goujard Cécile, Grandpeix Catherine, Grange Claire, Grimaldi Lamiae, Guettrot-Imbert Gaëlle, Guillevin Loïc, Hachulla Eric, Harle Jean-Robert, Haroche Julien, Hausfater Pierre, Jouquan Jean, Kaplanski Gilles, Keshtmand Homa, Khellaf Mehdi, Lambotte Olivier, Launay David, Lechat Philippe, Levesque Hervé, Lidove Olivier, Liozon Eric, Ly Kim, Mahevas Matthieu, Mariampillai Kubéraka, Mathian Alexis, Mazodier Karin, Michel Marc, Morel Nathalie, Mouthon Luc, Musset Lucile, Ngack Rokiya, Ninet Jacques, Oksenhendler Eric, Pellegrin Jean-Luc, Peyr Olivier, Piette Anne-Marie, Poindron Vincent, Pourrat Jacques, Roux Fabienne, Saadoun David, Sahali Sabrinel, Saint-Marcoux Bernadette, Sarrot-Reynauld Françoise, Schoindre Yoland, Sene Damien, Serratrice Jacques, Seve Pascal, Sibilia Jean, Simon Claude, Sordet Christelle, Terrier Benjamin, Trad Salim, Viallard Jean-François, Vidal Elisabeth, Wechsler Bertrand, Weiller Pierre-Jean, Jourde-Chiche Noémie, Costedoat-Chalumeau NathalieORCID,
Abstract
Abstract
Background
Hydroxychloroquine (HCQ) levels can be measured in both serum and whole blood. No cut-off point for non-adherence has been established in serum nor have these methods ever been compared. The aims of this study were to compare these two approaches and determine if serum HCQ cut-off points can be established to identify non-adherent patients.
Methods
HCQ levels were measured in serum and whole blood from 573 patients with systemic lupus erythematosus (SLE). The risk factors for active SLE (SLEDAI score > 4) were identified by multiple logistic regression. Serum HCQ levels were measured in 68 additional patients known to be non-adherent, i.e. with whole-blood HCQ < 200 ng/mL.
Results
The mean (± SD) HCQ levels were 469 ± 223 ng/mL in serum and 916 ± 449 ng/mL in whole blood. The mean ratio of serum/whole-blood HCQ levels was 0.53 ± 0.15. In the multivariate analysis, low whole-blood HCQ levels (P = 0.023), but not serum HCQ levels, were independently associated with active SLE.
From the mean serum/whole-blood level ratio, a serum HCQ level of 106 ng/mL was extrapolated as the corresponding cut-off to identify non-adherent patients with a sensitivity of 0.87 (95% CI 0.76–0.94) and specificity of 0.89 (95% CI 0.72–0.98).
All serum HCQ levels of patients with whole-blood HCQ below the detectable level (< 20 ng/mL) were also undetectable (< 20 ng/mL).
Conclusions
These data suggest that whole blood is better than serum for assessing the pharmacokinetic/pharmacodynamic relation of HCQ. Our results support the use of serum HCQ levels to assess non-adherence when whole blood is unavailable.
Funder
Ministère de la santé "French PHRC 2005"
Publisher
Springer Science and Business Media LLC
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