CHICAGO—The correct dosing of hydroxychloroquine (HCQ) for systemic lupus erythematosus (SLE) is a concern of all rheumatologists. Petros Efthimiou, MD, clinical professor of medicine at New York University, New York City, opened the Great Debate of the 2018 ACR/ARHP Annual Meeting by stating, “Today, we will be discussing a critical clinical problem that affects everyone’s practice.” He introduced Nathalie Costedoat-Chalumeau, MD, PhD, professor of internal medicine at Cochin Hospital, Paris, who began by introducing the pros and cons of the current HCQ controversy for patients with SLE. HCQ is indicated for the treatment of SLE, rheumatoid arthritis (RA) and other diseases.
Explore this issueFebruary 2019
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Benefits of HCQ for Patients with SLE
Dr. Costedoat-Chalumeau explained the beneficial effects of HCQ for SLE are clear. The drug improves survival. It prevents SLE flares and protects against diabetes, thrombotic events and dyslipidemia. It may also prevent congenital heart block in infants born to women with SLE.1,2 Because HCQ is safe to use during pregnancy and breastfeeding, the European League Against Rheumatism highly recommends it as an option during pregnancy for women with SLE.
Unfortunately, HCQ is also associated with ophthalmologic side effects, specifically clinical retinopathy with a characteristic bull’s-eye maculopathy. The American Academy of Ophthalmology (AAO) thus has recommendations on screening for chloroquine and HCQ retinopathy based on the daily dose of medication and duration of treatment. Less than 1% of patients have retinopathy at five years, but 20% of patients may develop it by 20 years.3-5