Hydroxychloroquine still underused by patients with lupus, but use more likely if treated by rheumatologists
Research Activities, September 2010, No. 361
Patients with systemic lupus erythematosus (SLE or lupus), an autoimmune disease, suffer early symptoms of fatigue, fever, joint pain, and lupus rash. Later, the disease can cause damage to organs such as the kidney, lungs, heart, blood, and nervous system. The disease is characterized by periodic and unpredictable flare-ups and is managed by a variety of medications. Hydroxychloroquine (HCQ) treatment has emerged as a key therapy for patients with lupus. HCQ, an antimalarial medication, may reduce progression of the disease, reduce diabetes, improve lipid profiles, and prolong survival of patients with lupus. It also appears to be inexpensive, safe, and well-tolerated. Yet, HCQ remains underused by patients with lupus, according to a new study. While patients receiving lupus care through a rheumatologist were twice as likely to use HCQ as those seeing other specialists or generalists, rheumatologists still only prescribed HCQ in 62 percent of patient-years.
The researchers sought to determine the prevalence of HCQ use in a diverse, community-based group of patients with SLE and to identify predictors of HCQ use. Overall, 55 percent of patients reported HCQ use each year, a figure that remained constant throughout the observation period (2002-2006). Patients who had SLE for a longer period were less likely to be taking HCQ. For each additional 10 years of disease duration, there was a 27 percent decrease in the odds of taking HCQ. The researchers speculate that patients with longer disease duration may have taken HCQ in the past and stopped because of disease quiescence, lack of perceived efficacy, or adverse effects.
Contrary to the researchers' initial hypothesis, the results also showed that there was no difference in disease activity between HCQ users and nonusers. The relationship between lupus disease duration and HCQ use, as well as patient and physician factors that contribute to HCQ underuse, need to be better understood, note the researchers. A total of 887 patients contributing 3,095 person-years of data were interviewed during the study period. The study was partly supported by the Agency for Healthcare Research and Quality (HS13893).
See "Hydroxychloroquine treatment in a community-based cohort of patients with systemic lupus erythematosus," by Gabriela Schmajuk, M.D., Jinoos Yazdany, M.D., M.P.H., Laura Trupin, M.P.H., and Edward Yelin, Ph.D., in the March 2010 Arthritis Care & Research 62(3), pp. 386-392.