Comparison of flares in 85 patients with SLE who maintained, discontinued or reduced dose of hydroxychloroquine during a prospective study of ophthalmological screening for retinopathy (PERFOCTAPS Study)
Objective Little is known about the risk of SLE flares associated with hydroxychloroquine (HCQ) reduction or cessation, especially after ophthalmological screening. We analysed the risk of SLE flares after HCQ reduction or discontinuation after detection of early ophthalmological toxicity.Methods Th...
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BMJ Publishing Group
2025-03-01
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| Series: | Lupus Science and Medicine |
| Online Access: | https://lupus.bmj.com/content/12/1/e001434.full |
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| author | Nathalie Costedoat-Chalumeau Alexis Mathian Luc Mouthon Yann Nguyen Kevin Chevalier Veronique Le Guern Nathalie Morel Vivien Vasseur Joana Isabel Marques Dias Elsa Laumonier Sabine Derrien Martine Mauget Faÿsse |
| author_facet | Nathalie Costedoat-Chalumeau Alexis Mathian Luc Mouthon Yann Nguyen Kevin Chevalier Veronique Le Guern Nathalie Morel Vivien Vasseur Joana Isabel Marques Dias Elsa Laumonier Sabine Derrien Martine Mauget Faÿsse |
| author_sort | Nathalie Costedoat-Chalumeau |
| collection | DOAJ |
| description | Objective Little is known about the risk of SLE flares associated with hydroxychloroquine (HCQ) reduction or cessation, especially after ophthalmological screening. We analysed the risk of SLE flares after HCQ reduction or discontinuation after detection of early ophthalmological toxicity.Methods This study includes all patients with SLE among the 109 included in the prospective PERFOCTAPS Study and treated with HCQ for at least 5 years. Patients were divided into 3 groups: HCQ maintenance, reduction and discontinuation after intensive ophthalmological screening. Flare occurrence (SELENA-SLEDAI Flare Index) was assessed for 2 years after HCQ reduction or discontinuation or after inclusion in the maintenance group.Results This study included 85 patients (98% women, mean age 40.0 years, and mean durations of SLE and HCQ treatment 14.4±7.7 years and 12.9±7.2 years, respectively). The PERFOCTAPS Study identified ophthalmological abnormalities in 25 patients (29.4%); these led to dose reduction in 20 patients and discontinuation in 5. Flares occurred in 29 patients (34.1%): 17 (28.3%) in the maintenance group, 10 (50%) in the reduction group and 2 (40%) in the discontinuation group. After adjustment for potential confounders, HCQ reduction was independently associated with the risk of flare (adjusted HR 2.26; 95% CI 1.03 to 4.97). The same trend was observed in the discontinuation group, but was no longer statistically significant (adjusted HR 2.13; 95% CI 0.44 to 10.27).Conclusion In this prospective study, HCQ reduction due to early suspicion of retinal toxicity was associated with a statistically significantly increased risk of disease flare.Trial registration number NCT02719002. |
| format | Article |
| id | doaj-art-771a0596de5c4c50939c7e2cf90a3053 |
| institution | Kabale University |
| issn | 2053-8790 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Lupus Science and Medicine |
| spelling | doaj-art-771a0596de5c4c50939c7e2cf90a30532025-08-20T03:44:28ZengBMJ Publishing GroupLupus Science and Medicine2053-87902025-03-0112110.1136/lupus-2024-001434Comparison of flares in 85 patients with SLE who maintained, discontinued or reduced dose of hydroxychloroquine during a prospective study of ophthalmological screening for retinopathy (PERFOCTAPS Study)Nathalie Costedoat-Chalumeau0Alexis Mathian1Luc Mouthon2Yann Nguyen3Kevin Chevalier4Veronique Le Guern5Nathalie Morel6Vivien Vasseur7Joana Isabel Marques Dias8Elsa Laumonier9Sabine Derrien10Martine Mauget Faÿsse11Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d’Ile de France, AP-HP.Centre, Université Paris Cité, Hospital Cochin, Paris, France1 Assistance Publique-Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié-Salpêtrière, Centre de Référence pour le Lupus, le Syndrome des anti-phospholipides et autres maladies auto-immunes rares, Service de Médecine Interne 2, Institut E3M, Paris, FranceDepartment of Internal Medicine, Hopital Cochin, Paris, Île-de-France, FranceService de médecine interne, Hôpital Beaujon, AP-HP.Nord, Université Paris Cité, Clichy, FranceDepartment of Internal Medicine, National Referral Center for Adult Immune Cytopenias Henri Mondor University Hospital, Service de Medecine Interne, CHU Hopital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, 51 Av du Mal de Lattre de Tassigny, 94010 Creteil Cedex, France, Créteil, FranceDepartment of Internal Medicine, APHP, Paris, France3National Referral Centre for Rare Autoimmune and Systemic Diseases, Dept. of Internal Medicine, Hôpital Cochin, AP-HP Centre, Université de Paris, Paris2 Department of Vitreo-retinal Surgery, Rothschild Ophthalmologic Foundation, Paris, FranceInternal Medicine, Hospital Beatriz Angelo, Loures, Lisboa, PortugalElectrophysiology Department, Rothschild Foundation Hospital, Paris, FranceElectrophysiology Department, Rothschild Foundation Hospital, Paris, FranceClinical Investigation Platform, Rothschild Foundation Hospital, Paris, FranceObjective Little is known about the risk of SLE flares associated with hydroxychloroquine (HCQ) reduction or cessation, especially after ophthalmological screening. We analysed the risk of SLE flares after HCQ reduction or discontinuation after detection of early ophthalmological toxicity.Methods This study includes all patients with SLE among the 109 included in the prospective PERFOCTAPS Study and treated with HCQ for at least 5 years. Patients were divided into 3 groups: HCQ maintenance, reduction and discontinuation after intensive ophthalmological screening. Flare occurrence (SELENA-SLEDAI Flare Index) was assessed for 2 years after HCQ reduction or discontinuation or after inclusion in the maintenance group.Results This study included 85 patients (98% women, mean age 40.0 years, and mean durations of SLE and HCQ treatment 14.4±7.7 years and 12.9±7.2 years, respectively). The PERFOCTAPS Study identified ophthalmological abnormalities in 25 patients (29.4%); these led to dose reduction in 20 patients and discontinuation in 5. Flares occurred in 29 patients (34.1%): 17 (28.3%) in the maintenance group, 10 (50%) in the reduction group and 2 (40%) in the discontinuation group. After adjustment for potential confounders, HCQ reduction was independently associated with the risk of flare (adjusted HR 2.26; 95% CI 1.03 to 4.97). The same trend was observed in the discontinuation group, but was no longer statistically significant (adjusted HR 2.13; 95% CI 0.44 to 10.27).Conclusion In this prospective study, HCQ reduction due to early suspicion of retinal toxicity was associated with a statistically significantly increased risk of disease flare.Trial registration number NCT02719002.https://lupus.bmj.com/content/12/1/e001434.full |
| spellingShingle | Nathalie Costedoat-Chalumeau Alexis Mathian Luc Mouthon Yann Nguyen Kevin Chevalier Veronique Le Guern Nathalie Morel Vivien Vasseur Joana Isabel Marques Dias Elsa Laumonier Sabine Derrien Martine Mauget Faÿsse Comparison of flares in 85 patients with SLE who maintained, discontinued or reduced dose of hydroxychloroquine during a prospective study of ophthalmological screening for retinopathy (PERFOCTAPS Study) Lupus Science and Medicine |
| title | Comparison of flares in 85 patients with SLE who maintained, discontinued or reduced dose of hydroxychloroquine during a prospective study of ophthalmological screening for retinopathy (PERFOCTAPS Study) |
| title_full | Comparison of flares in 85 patients with SLE who maintained, discontinued or reduced dose of hydroxychloroquine during a prospective study of ophthalmological screening for retinopathy (PERFOCTAPS Study) |
| title_fullStr | Comparison of flares in 85 patients with SLE who maintained, discontinued or reduced dose of hydroxychloroquine during a prospective study of ophthalmological screening for retinopathy (PERFOCTAPS Study) |
| title_full_unstemmed | Comparison of flares in 85 patients with SLE who maintained, discontinued or reduced dose of hydroxychloroquine during a prospective study of ophthalmological screening for retinopathy (PERFOCTAPS Study) |
| title_short | Comparison of flares in 85 patients with SLE who maintained, discontinued or reduced dose of hydroxychloroquine during a prospective study of ophthalmological screening for retinopathy (PERFOCTAPS Study) |
| title_sort | comparison of flares in 85 patients with sle who maintained discontinued or reduced dose of hydroxychloroquine during a prospective study of ophthalmological screening for retinopathy perfoctaps study |
| url | https://lupus.bmj.com/content/12/1/e001434.full |
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