治疗性羟氯喹血药浓度与红斑狼疮住院率降低有关,并可减少红斑狼疮的健康差异。

IF 3.7 2区 医学 Q1 RHEUMATOLOGY Arthritis Care & Research Pub Date : 2024-08-26 DOI:10.1002/acr.25422
Shivani Garg, Brad C Astor, Callie Saric, Giancarlo Valiente, Lexie Kolton, Betty Chewning, Christie M Bartels
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摘要

背景:不坚持使用羟氯喹(HCQ)会导致狼疮相关住院风险增加 3 倍。监测HCQ血药浓度可提高依从性和疗效。然而,部分由于成本和覆盖面的原因,HCQ水平监测并没有常规化。为确定 HCQ 水平监测的成本效益,我们报告了以下几点方法:在狼疮常规就诊期间测量 HCQ 血液水平。HCQ水平可分为:a)亚治疗水平(1200纳克/毫升);b)治疗水平(100纳克/毫升);c)治疗水平(100纳克/毫升)。我们还摘录了所有与狼疮相关的急性就诊病例(急诊室就诊/住院),这些病例都是在就诊后至下次随访前就诊的。在主要分析中,我们研究了所有患者和急诊就诊率较高的亚组的 HCQ 水平与首次急诊就诊时间之间的关系:结果:在181名患者中,共观察到39次与狼疮相关的急诊就诊。治疗性HCQ血药浓度与急诊就诊率降低66%有关。在我们的队列中,黑人或西班牙裔人以及有公共保险的人这两类人的急诊就诊率要高出3-4倍。在急症护理使用率较高的亚组中,HCQ血药浓度在750-1200纳克/毫升范围内与急症护理使用率降低95%相关:结论:HCQ血药浓度在750-1200纳克/毫升范围内与所有红斑狼疮患者(包括急性护理使用率较高的群体)的急性护理使用率降低有关。未来的临床试验应确定红斑狼疮患者的HCQ水平监测与急性护理使用之间的因果关系。
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Therapeutic Hydroxychloroquine Blood Levels Are Associated With Fewer Hospitalizations and Possible Reduction of Health Disparities in Lupus.

Objective: Nonadherence to receiving hydroxychloroquine (HCQ) is associated with a three-fold higher risk of lupus-related hospitalization. Monitoring HCQ blood levels could improve adherence to receiving HCQ and efficacy. Yet, HCQ level monitoring is not routinely done partially due to cost and coverage concerns. To establish HCQ level monitoring cost-effectiveness, we reported the following: (1) risk of acute care by HCQ blood levels, and (2) cost of HCQ monitoring versus acute care visits.

Methods: HCQ blood levels were measured during routine lupus visits. HCQ levels were categorized as follows: (1) subtherapeutic (<750 ng/mL), (2) therapeutic (750-1,200 ng/mL), or (3) supratherapeutic (>1,200 ng/mL). All lupus-related acute care visits (emergency room visits/hospitalizations) after the index clinic visit until next follow-up were abstracted. In our primary analysis, we examined associations between HCQ levels and time to first acute care visit in all patients and subgroups with higher rates of acute care.

Results: A total of 39 lupus-related acute care visits were observed in 181 patients. Therapeutic HCQ blood levels were associated with 66% lower rates of acute care. In our cohort, two groups, Black or Hispanic patients and those with public insurance, faced three to four times higher rates of acute care. Levels within 750 to 1,200 ng/mL were associated with 95% lower rates of acute care use in subgroups with higher acute care use.

Conclusion: HCQ blood levels within 750 to 1,200 ng/mL are associated with lower rates of acute care in all patients with lupus, including groups with higher rates of acute care. Future clinical trials should establish the causal association between HCQ level monitoring and acute care in patients with lupus.

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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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