Should Hydroxychloroquine Levels be Utilized to Guide an Increase in the Dose of Medication?
Aside from identifying patients at risk for toxicities, hydroxychloroquine levels can also be utilized to guide the need for increasing the dose of the medication. A study published in 2016 in Journal of American Academy of Dermatology included 34 patients with active cutaneous lupus (defined by CLASI or Revised CLASI score) and hydroxychloroquine level 750 ng/ml or less. The dose of hydroxychloroquine was increased by 200 mg per day and hydroxychloroquine levels were reassessed at 3 months. For those with persistently low levels, the dose was again increased by 200 mg with repeat level in 3 months. It should be noted that doses utilized in the trial exceeded those recommended by recent AAO guidelines with maximum daily dose of 800 mg/day in some study patients. With the increased hydroxychloroquine level, however, the investigators found a statistically significant decrease in both CLASI and RCLASI score (P values <0.001 for both). The hydroxychloroquine levels increased from 638 ng/ml at baseline to 1187 ng/ml. This study supports the notion that an increased hydroxychloroquine level improves disease activity. Although such high doses of hydroxychloroquine are not currently recommended in clinical practice.
Curr Opin Rheumatol. 2022;34(3):151-157. © 2022 Lippincott Williams & Wilkins