Safe Introduction of Hydroxychloroquine Focusing on Early Intolerance Due to Adverse Drug Reactions in Patients with Systemic Lupus Erythematosus
Objective This study explored the predictors of hydroxychloroquine intolerance and propose appropriate methods to initiate hydroxychloroquine in patients with systemic lupus erythematosus. Methods This retrospective study registered consecutive patients who were diagnosed with systemic lupus erythem...
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| Veröffentlicht in: | Internal Medicine 2023/07/15, Vol.62(14), pp.2051-2057 |
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| creator | Yoshida, Yusuke Oka, Naoya Yorishima, Ai Masuda, Sho Ishitoku, Michinori Araki, Kei Kohno, Hiroki Watanabe, Hirofumi Sugimoto, Tomohiro Mokuda, Sho Hirata, Shintaro |
| description | Objective This study explored the predictors of hydroxychloroquine intolerance and propose appropriate methods to initiate hydroxychloroquine in patients with systemic lupus erythematosus. Methods This retrospective study registered consecutive patients who were diagnosed with systemic lupus erythematosus and started treatment with hydroxychloroquine between 2015 and 2021. Any adverse events that required dose reduction or cessation of hydroxychloroquine, indicating intolerance to the drug, were recorded for up to 26 weeks after initiation of hydroxychloroquine. Results A total of 130 patients were included. Hydroxychloroquine intolerance due to adverse drug reactions was observed in 28 patients (21.5%), including gastrointestinal symptoms in 15 (11.5%) and cutaneous reactions in 7 (5.4%). Furthermore, the intolerance was observed more frequently in the maintenance group (patients treated daily with |
| doi_str_mv | 10.2169/internalmedicine.0961-22 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10400396</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2850466798</sourcerecordid><originalsourceid>FETCH-LOGICAL-c611t-7ab544d2ca87bedb60a1df25e0a71cd5592c9344ed4cebfe6a4a6591e96b70813</originalsourceid><addsrcrecordid>eNplkd9u0zAUxiMEYmXwCsgSN9xk2I7jxFdoGh2bVGmIwbXlOCetq9Qu_jPIY_DGOLRUMG6OZfl3vu_4fEWBCL6ghIt3xkbwVo076I02Fi6w4KSk9EmxIBUTZUOr-mmxwIK0Jc3lrHgRwhbjqm0EfV6cVbxqmcBsUfy8VwOgWxu965OOxlnkBnQz9d79mPRmdN59S9kBXTudgrFrlIml8uM0N7kRvLIa0IcEKDp02T-AD_nq0xp9BvVbMCBj0ScVDdgY0HcTN-h-ChF2RqNV2qeAln6KG9ip6EIKL4tngxoDvDqe58XX6-WXq5tydffx9upyVWpOSCwb1dWM9VSrtumg7zhWpB9oDVg1RPd1LagWFWPQMw3dAFwxxWtBQPCuwS2pzov3B9196vIedZ7Oq1HuvdkpP0mnjPz3xZqNXLsHSTDLmxQ8K7w9KsxLghDlzgQN46gsuBQkbaqGcUbEbPbmEbp1aU4wU22NGeeNaDPVHijtXQgehtM0BMs5ePk4eDkHLynNra___s2p8U_SGbg7ANsQ1RpOgPLR6BH-V-ZUEjbXo8WJ1BvlJdjqFwOW0Ro</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2850466798</pqid></control><display><type>article</type><title>Safe Introduction of Hydroxychloroquine Focusing on Early Intolerance Due to Adverse Drug Reactions in Patients with Systemic Lupus Erythematosus</title><source>J-STAGE Free</source><source>MEDLINE</source><source>PubMed Central Open Access</source><source>PubMed Central</source><creator>Yoshida, Yusuke ; Oka, Naoya ; Yorishima, Ai ; Masuda, Sho ; Ishitoku, Michinori ; Araki, Kei ; Kohno, Hiroki ; Watanabe, Hirofumi ; Sugimoto, Tomohiro ; Mokuda, Sho ; Hirata, Shintaro</creator><creatorcontrib>Yoshida, Yusuke ; Oka, Naoya ; Yorishima, Ai ; Masuda, Sho ; Ishitoku, Michinori ; Araki, Kei ; Kohno, Hiroki ; Watanabe, Hirofumi ; Sugimoto, Tomohiro ; Mokuda, Sho ; Hirata, Shintaro</creatorcontrib><description>Objective This study explored the predictors of hydroxychloroquine intolerance and propose appropriate methods to initiate hydroxychloroquine in patients with systemic lupus erythematosus. Methods This retrospective study registered consecutive patients who were diagnosed with systemic lupus erythematosus and started treatment with hydroxychloroquine between 2015 and 2021. Any adverse events that required dose reduction or cessation of hydroxychloroquine, indicating intolerance to the drug, were recorded for up to 26 weeks after initiation of hydroxychloroquine. Results A total of 130 patients were included. Hydroxychloroquine intolerance due to adverse drug reactions was observed in 28 patients (21.5%), including gastrointestinal symptoms in 15 (11.5%) and cutaneous reactions in 7 (5.4%). Furthermore, the intolerance was observed more frequently in the maintenance group (patients treated daily with <20 mg prednisolone) than in the induction group (7.1% vs. 25.5%, p=0.04), and none of the patients in the induction group developed cutaneous reactions. The initial dose of hydroxychloroquine per ideal body weight was associated with hydroxychloroquine intolerance in a dose-dependent manner. Multivariable analyses revealed that the hydroxychloroquine dose per ideal body weight and higher levels of C4 predicted hydroxychloroquine intolerance. In particular, C4 levels were positively correlated with cutaneous reactions, whereas the dose of prednisolone was negatively correlated with gastrointestinal reactions. Conclusion Low-dose hydroxychloroquine may be optimal for induction in patients with systemic lupus erythematosus who have high C4 levels or are taking low doses of steroids.</description><identifier>ISSN: 0918-2918</identifier><identifier>EISSN: 1349-7235</identifier><identifier>DOI: 10.2169/internalmedicine.0961-22</identifier><identifier>PMID: 36384904</identifier><language>eng</language><publisher>Japan: The Japanese Society of Internal Medicine</publisher><subject>adverse drug reaction ; Body weight ; complement ; Drug dosages ; Drug-Related Side Effects and Adverse Reactions ; glucocorticoids ; Humans ; Hydroxychloroquine ; Hydroxychloroquine - adverse effects ; Internal medicine ; Intolerance ; Lupus ; Lupus Erythematosus, Systemic - chemically induced ; Lupus Erythematosus, Systemic - drug therapy ; Original ; Prednisolone ; Prednisolone - adverse effects ; Retrospective Studies ; Steroid hormones ; Systemic lupus erythematosus</subject><ispartof>Internal Medicine, 2023/07/15, Vol.62(14), pp.2051-2057</ispartof><rights>2023 by The Japanese Society of Internal Medicine</rights><rights>Copyright Japan Science and Technology Agency 2023</rights><rights>Copyright © 2023 by The Japanese Society of Internal Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c611t-7ab544d2ca87bedb60a1df25e0a71cd5592c9344ed4cebfe6a4a6591e96b70813</citedby><cites>FETCH-LOGICAL-c611t-7ab544d2ca87bedb60a1df25e0a71cd5592c9344ed4cebfe6a4a6591e96b70813</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10400396/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10400396/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,1883,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36384904$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yoshida, Yusuke</creatorcontrib><creatorcontrib>Oka, Naoya</creatorcontrib><creatorcontrib>Yorishima, Ai</creatorcontrib><creatorcontrib>Masuda, Sho</creatorcontrib><creatorcontrib>Ishitoku, Michinori</creatorcontrib><creatorcontrib>Araki, Kei</creatorcontrib><creatorcontrib>Kohno, Hiroki</creatorcontrib><creatorcontrib>Watanabe, Hirofumi</creatorcontrib><creatorcontrib>Sugimoto, Tomohiro</creatorcontrib><creatorcontrib>Mokuda, Sho</creatorcontrib><creatorcontrib>Hirata, Shintaro</creatorcontrib><title>Safe Introduction of Hydroxychloroquine Focusing on Early Intolerance Due to Adverse Drug Reactions in Patients with Systemic Lupus Erythematosus</title><title>Internal Medicine</title><addtitle>Intern. Med.</addtitle><description>Objective This study explored the predictors of hydroxychloroquine intolerance and propose appropriate methods to initiate hydroxychloroquine in patients with systemic lupus erythematosus. Methods This retrospective study registered consecutive patients who were diagnosed with systemic lupus erythematosus and started treatment with hydroxychloroquine between 2015 and 2021. Any adverse events that required dose reduction or cessation of hydroxychloroquine, indicating intolerance to the drug, were recorded for up to 26 weeks after initiation of hydroxychloroquine. Results A total of 130 patients were included. Hydroxychloroquine intolerance due to adverse drug reactions was observed in 28 patients (21.5%), including gastrointestinal symptoms in 15 (11.5%) and cutaneous reactions in 7 (5.4%). Furthermore, the intolerance was observed more frequently in the maintenance group (patients treated daily with <20 mg prednisolone) than in the induction group (7.1% vs. 25.5%, p=0.04), and none of the patients in the induction group developed cutaneous reactions. The initial dose of hydroxychloroquine per ideal body weight was associated with hydroxychloroquine intolerance in a dose-dependent manner. Multivariable analyses revealed that the hydroxychloroquine dose per ideal body weight and higher levels of C4 predicted hydroxychloroquine intolerance. In particular, C4 levels were positively correlated with cutaneous reactions, whereas the dose of prednisolone was negatively correlated with gastrointestinal reactions. Conclusion Low-dose hydroxychloroquine may be optimal for induction in patients with systemic lupus erythematosus who have high C4 levels or are taking low doses of steroids.</description><subject>adverse drug reaction</subject><subject>Body weight</subject><subject>complement</subject><subject>Drug dosages</subject><subject>Drug-Related Side Effects and Adverse Reactions</subject><subject>glucocorticoids</subject><subject>Humans</subject><subject>Hydroxychloroquine</subject><subject>Hydroxychloroquine - adverse effects</subject><subject>Internal medicine</subject><subject>Intolerance</subject><subject>Lupus</subject><subject>Lupus Erythematosus, Systemic - chemically induced</subject><subject>Lupus Erythematosus, Systemic - drug therapy</subject><subject>Original</subject><subject>Prednisolone</subject><subject>Prednisolone - adverse effects</subject><subject>Retrospective Studies</subject><subject>Steroid hormones</subject><subject>Systemic lupus erythematosus</subject><issn>0918-2918</issn><issn>1349-7235</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplkd9u0zAUxiMEYmXwCsgSN9xk2I7jxFdoGh2bVGmIwbXlOCetq9Qu_jPIY_DGOLRUMG6OZfl3vu_4fEWBCL6ghIt3xkbwVo076I02Fi6w4KSk9EmxIBUTZUOr-mmxwIK0Jc3lrHgRwhbjqm0EfV6cVbxqmcBsUfy8VwOgWxu965OOxlnkBnQz9d79mPRmdN59S9kBXTudgrFrlIml8uM0N7kRvLIa0IcEKDp02T-AD_nq0xp9BvVbMCBj0ScVDdgY0HcTN-h-ChF2RqNV2qeAln6KG9ip6EIKL4tngxoDvDqe58XX6-WXq5tydffx9upyVWpOSCwb1dWM9VSrtumg7zhWpB9oDVg1RPd1LagWFWPQMw3dAFwxxWtBQPCuwS2pzov3B9196vIedZ7Oq1HuvdkpP0mnjPz3xZqNXLsHSTDLmxQ8K7w9KsxLghDlzgQN46gsuBQkbaqGcUbEbPbmEbp1aU4wU22NGeeNaDPVHijtXQgehtM0BMs5ePk4eDkHLynNra___s2p8U_SGbg7ANsQ1RpOgPLR6BH-V-ZUEjbXo8WJ1BvlJdjqFwOW0Ro</recordid><startdate>20230715</startdate><enddate>20230715</enddate><creator>Yoshida, Yusuke</creator><creator>Oka, Naoya</creator><creator>Yorishima, Ai</creator><creator>Masuda, Sho</creator><creator>Ishitoku, Michinori</creator><creator>Araki, Kei</creator><creator>Kohno, Hiroki</creator><creator>Watanabe, Hirofumi</creator><creator>Sugimoto, Tomohiro</creator><creator>Mokuda, Sho</creator><creator>Hirata, Shintaro</creator><general>The Japanese Society of Internal Medicine</general><general>Japan Science and Technology Agency</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230715</creationdate><title>Safe Introduction of Hydroxychloroquine Focusing on Early Intolerance Due to Adverse Drug Reactions in Patients with Systemic Lupus Erythematosus</title><author>Yoshida, Yusuke ; Oka, Naoya ; Yorishima, Ai ; Masuda, Sho ; Ishitoku, Michinori ; Araki, Kei ; Kohno, Hiroki ; Watanabe, Hirofumi ; Sugimoto, Tomohiro ; Mokuda, Sho ; Hirata, Shintaro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c611t-7ab544d2ca87bedb60a1df25e0a71cd5592c9344ed4cebfe6a4a6591e96b70813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>adverse drug reaction</topic><topic>Body weight</topic><topic>complement</topic><topic>Drug dosages</topic><topic>Drug-Related Side Effects and Adverse Reactions</topic><topic>glucocorticoids</topic><topic>Humans</topic><topic>Hydroxychloroquine</topic><topic>Hydroxychloroquine - adverse effects</topic><topic>Internal medicine</topic><topic>Intolerance</topic><topic>Lupus</topic><topic>Lupus Erythematosus, Systemic - chemically induced</topic><topic>Lupus Erythematosus, Systemic - drug therapy</topic><topic>Original</topic><topic>Prednisolone</topic><topic>Prednisolone - adverse effects</topic><topic>Retrospective Studies</topic><topic>Steroid hormones</topic><topic>Systemic lupus erythematosus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yoshida, Yusuke</creatorcontrib><creatorcontrib>Oka, Naoya</creatorcontrib><creatorcontrib>Yorishima, Ai</creatorcontrib><creatorcontrib>Masuda, Sho</creatorcontrib><creatorcontrib>Ishitoku, Michinori</creatorcontrib><creatorcontrib>Araki, Kei</creatorcontrib><creatorcontrib>Kohno, Hiroki</creatorcontrib><creatorcontrib>Watanabe, Hirofumi</creatorcontrib><creatorcontrib>Sugimoto, Tomohiro</creatorcontrib><creatorcontrib>Mokuda, Sho</creatorcontrib><creatorcontrib>Hirata, Shintaro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Internal Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yoshida, Yusuke</au><au>Oka, Naoya</au><au>Yorishima, Ai</au><au>Masuda, Sho</au><au>Ishitoku, Michinori</au><au>Araki, Kei</au><au>Kohno, Hiroki</au><au>Watanabe, Hirofumi</au><au>Sugimoto, Tomohiro</au><au>Mokuda, Sho</au><au>Hirata, Shintaro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safe Introduction of Hydroxychloroquine Focusing on Early Intolerance Due to Adverse Drug Reactions in Patients with Systemic Lupus Erythematosus</atitle><jtitle>Internal Medicine</jtitle><addtitle>Intern. Med.</addtitle><date>2023-07-15</date><risdate>2023</risdate><volume>62</volume><issue>14</issue><spage>2051</spage><epage>2057</epage><pages>2051-2057</pages><artnum>0961-22</artnum><issn>0918-2918</issn><eissn>1349-7235</eissn><abstract>Objective This study explored the predictors of hydroxychloroquine intolerance and propose appropriate methods to initiate hydroxychloroquine in patients with systemic lupus erythematosus. Methods This retrospective study registered consecutive patients who were diagnosed with systemic lupus erythematosus and started treatment with hydroxychloroquine between 2015 and 2021. Any adverse events that required dose reduction or cessation of hydroxychloroquine, indicating intolerance to the drug, were recorded for up to 26 weeks after initiation of hydroxychloroquine. Results A total of 130 patients were included. Hydroxychloroquine intolerance due to adverse drug reactions was observed in 28 patients (21.5%), including gastrointestinal symptoms in 15 (11.5%) and cutaneous reactions in 7 (5.4%). Furthermore, the intolerance was observed more frequently in the maintenance group (patients treated daily with <20 mg prednisolone) than in the induction group (7.1% vs. 25.5%, p=0.04), and none of the patients in the induction group developed cutaneous reactions. The initial dose of hydroxychloroquine per ideal body weight was associated with hydroxychloroquine intolerance in a dose-dependent manner. Multivariable analyses revealed that the hydroxychloroquine dose per ideal body weight and higher levels of C4 predicted hydroxychloroquine intolerance. In particular, C4 levels were positively correlated with cutaneous reactions, whereas the dose of prednisolone was negatively correlated with gastrointestinal reactions. Conclusion Low-dose hydroxychloroquine may be optimal for induction in patients with systemic lupus erythematosus who have high C4 levels or are taking low doses of steroids.</abstract><cop>Japan</cop><pub>The Japanese Society of Internal Medicine</pub><pmid>36384904</pmid><doi>10.2169/internalmedicine.0961-22</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | adverse drug reaction Body weight complement Drug dosages Drug-Related Side Effects and Adverse Reactions glucocorticoids Humans Hydroxychloroquine Hydroxychloroquine - adverse effects Internal medicine Intolerance Lupus Lupus Erythematosus, Systemic - chemically induced Lupus Erythematosus, Systemic - drug therapy Original Prednisolone Prednisolone - adverse effects Retrospective Studies Steroid hormones Systemic lupus erythematosus |
| title | Safe Introduction of Hydroxychloroquine Focusing on Early Intolerance Due to Adverse Drug Reactions in Patients with Systemic Lupus Erythematosus |
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