Hydroxychloroquine levels in patients with systemic lupus erythematosus: whole blood is preferable but serum levels also
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(2020) 22:223
RESEARCH ARTICLE
Open Access
Hydroxychloroquine levels in patients with systemic lupus erythematosus: whole blood is preferable but serum levels also detect non-adherence Benoit Blanchet1,2, Moez Jallouli3, Marie Allard4,5, Pascale Ghillani-Dalbin6, Lionel Galicier7,8, Olivier Aumaître9,10, François Chasset11,12, Véronique Le Guern13, Frédéric Lioté14,15, Amar Smail16, Nicolas Limal17, Laurent Perard18, Hélène Desmurs-Clavel19, Du Le Thi Huong11,20, Bouchra Asli7,8, Jean-Emmanuel Kahn21, Laurent Sailler22,23, Félix Ackermann24, Thomas Papo4,5, Karim Sacré4,5, Olivier Fain25, Jérôme Stirnemann26, Patrice Cacoub11,27, Gaelle Leroux11,27, Judith Cohen-Bittan28, Jérémie Sellam29, Xavier Mariette30, Claire Goulvestre31, Jean Sébastien Hulot32, Zahir Amoura11,20, Michel Vidal1,2, Jean-Charles Piette11,27, on behalf of the PLUS Group, Noémie Jourde-Chiche33 and Nathalie Costedoat-Chalumeau13,34,35*
Abstract Background: Hydroxychloroquine (HCQ) levels can be measured in both serum and whole blood. No cut-off point for nonadherence 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 cutoff 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). (Continued on next page)
* Correspondence: [email protected] This work was presented at Annual European Congress of Rheumatology, EULAR 2019, Madrid, 12–15 June 2019. 13 AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France 34 Université Paris-Descartes, Paris, France Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the
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