Низкий уровень гидроксихлорохина у пациентов с системной красной волчанкой повышает риск сердечно-сосудистых заболеваний

Low hydroxychloroquine intake, blood levels increase cardiovascular risk in lupus Key takeaways: - Low hydroxychloroquine blood levels and long-term adherence were linked to increased heart disease risk in systemic lupus erythematosus. - Monitoring hydroxychloroquine markers can support clinical decision-making in SLE. Patients with systemic lupus erythematosus and sustained low hydroxychloroquine blood levels may be at significantly increased risk for atherosclerotic cardiovascular disease, according to data published in Arthritis Care & Research. “Hydroxychloroquine (HCQ) is the cornerstone of SLE management because it reduces disease activity, prevents flares, limits organ damage accrual and has been associated with cardiovascular protection,” Shivani Garg, MD, PhD, director of the Yale Lupus Program, told Healio. “This study provides hypothesis-generating evidence that optimizing both HCQ blood levels and long-term adherence may influence cardiovascular risk in SLE.” In a prospective longitudinal study, Garg and colleagues analyzed data from 248 adult patients with SLE who took HCQ and had minimum 1-year follow-up. Their goal was to examine how HCQ blood levels and long-term intake impact atherosclerotic cardiovascular disease (ASCVD) risk at baseline and 1 year. The researchers assessed patients’ long-term HCQ intake using proportion of days covered (PDC), as well as HCQ blood levels. Low long-term HCQ intake was defined as PDC of less than 80%, while very low HCQ blood level was defined as less than 200 ng/mL. “Measuring HCQ blood levels provides an objective assessment of recent drug exposure, while refill-based measures capture long-term intake patterns,” Garg said. Researchers used the PREVENT calculator to assess patients’ 10-year risk for ASCVD. At baseline, patients with low long-term intake and very low HCQ blood levels demonstrated 2.1% greater risk for ASCVD and a mean predicted risk of 6.6%, according to the researchers. In addition, patients who sustained low HCQ markers, and patients who transitioned from high HCQ markers to low HCQ markers over 1 year, had the greatest predicted risk for ASCVD. “These findings suggest that both adequate HCQ exposure and sustained adherence over time may be important contributors to reducing cardiovascular risk in SLE,” Garg said. “Physicians should consider HCQ blood level monitoring and longitudinal adherence measures as complementary tools to support clinical decision-making,” she told Healio. “Together, these measures can help identify patients with inadequate exposure, distinguish nonadherence from pharmacokinetic variability, guide patient counseling and reinforce the long-term benefits of HCQ therapy.” For more information: Shivani Garg, MD, PhD, can be reached at [email protected].