PDF(Pubmed)
Abstract：
In the absence of evidence-based guidance on the impact of hydroxychloroquine (HCQ) blood concentration on efficacy and ocular toxicity in systemic lupus erythematosus (SLE), the clinical monitoring of HCQ blood concentration is not yet widely performed, which raised concerns about the necessity of conducting HCQ blood concentration monitoring. In this retrospective study, we consecutively enrolled 135 patients with SLE who received HCQ treatment for more than 6 months from July 2022 to December 2022. Ocular toxicity was evaluated by collecting relevant retinal parameters using optical coherence tomography angiography (OCTA). Therapeutic efficacy was evaluated using the SLE disease activity index (SLEDAI) and relevant clinical parameters. HCQ blood concentration was determined by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Spearman correlation analysis revealed that the cumulative dose of HCQ was positively correlated with the foveal avascular zone (FAZ) perimeter and FAZ area (r = 0.734, P < 0.001; r = 0.784, P < 0.001). Meanwhile, the treatment duration of HCQ was positively correlated with FAZ perimeter and FAZ area (r = 0.761, P < 0.001; r = 0.882, P < 0.001). The univariate and multivariate logistic regression analyses indicated that HCQ blood concentration was associated with the disease activity of patients with SLE (odds ratio 0.994, 95% CI 0.990-0.999). HCQ blood concentration may be an important factor in assessing the therapeutic effectiveness of SLE patients. The HCQ-related ocular toxicity was a long-term effect related to long term exposure, rather than the blood concentration of HCQ at the time of testing. More importantly, when addressing HCQ-related ocular toxicity, it may be crucial to pay attention to the cumulative dose and treatment duration of HCQ.
摘要：
在缺乏关于羟氯喹（HCQ）血药浓度对系统性红斑狼疮（SLE）疗效和眼部毒性影响的循证指导的情况下，HCQ血药浓度的临床监测尚未广泛进行，这引起了人们对进行HCQ血药浓度监测的必要性的担忧。在这项回顾性研究中,我们从2022年7月至2022年12月连续纳入135例接受HCQ治疗超过6个月的SLE患者.通过使用光学相干断层扫描血管造影（OCTA）收集相关的视网膜参数来评估眼毒性。使用SLE疾病活动指数（SLEDAI）和相关临床参数评估治疗效果。通过高效液相色谱-串联质谱法(HPLC-MS/MS)测定HCQ血药浓度。Spearman相关分析显示，HCQ的累积剂量与中央凹无血管区（FAZ）周长和FAZ面积呈正相关（r=0.734，P<0.001；r=0.784，P<0.001）。同时,HCQ治疗时间与FAZ周长、FAZ面积呈正相关(r=0.761,P<0.001;r=0.882,P<0.001)。单因素和多因素logistic回归分析显示HCQ血药浓度与SLE患者的疾病活动性相关(比值比0.994,95%CI0.990-0.999)。HCQ血药浓度可能是评估SLE患者治疗效果的重要因素。HCQ相关的眼部毒性是与长期暴露相关的长期效应，而不是检测时HCQ的血液浓度。更重要的是,在解决HCQ相关的眼部毒性时，注意HCQ的累积剂量和治疗持续时间可能是至关重要的。
