Therapeutic HCQ Levels Linked With Fewer Hospitalizations in Lupus

Monitoring hydroxychloroquine (HCQ) blood levels could reduce acute care utilization, particularly for patients who are more vulnerable to lupus-related hospitalizations, according to research published in Arthritis Care & Research.

The authors investigated the relationship between blood levels and the risk of lupus-related acute care visits, as well as the potential cost-effectiveness of monitoring HCQ levels. HCQ monitoring is not routinely performed due to concerns over costs and insurance coverage, despite evidence suggesting that nonadherence to HCQ significantly increases the risk of hospitalization. HCQ levels were categorized as subtherapeutic (<750 ng/mL), therapeutic (750–1,200 ng/mL), and supratherapeutic (>1,200 ng/mL), and their associations with acute care visits were examined in a cohort of 181 lupus patients.

Results showed that therapeutic HCQ levels were linked to a 66% reduction in acute care visits. Notably, Black and Hispanic patients, as well as those with public insurance, faced 3 to 4 times higher rates of acute care. However, maintaining HCQ levels within the therapeutic range (750–1,200 ng/mL) led to a 95% reduction in acute care visits among these high-risk groups.

Future clinical trials are recommended to establish a causal link between routine HCQ level monitoring and decreased acute care needs, which could support the widespread adoption of this practice and improve patient outcomes while potentially reducing health care costs, the authors concluded.

Reference
Garg S, Astor BC, Saric C, et al. Therapeutic hydroxychloroquine blood levels are associated with fewer hospitalizations and possible reduction of health disparities in lupus. Arthritis Care Res (Hoboken). Published online August 26, 2024. doi:10.1002/acr.25422