Advances in the clinical use of hydroxychloroquine levels

Abstract

Purpose of reviewThis review summarizes the recent literature exploring hydroxychloroquine levels and their relationship with disease activity and risk of toxicity. Recent findingsThere is no clear correlation between weight-based dosing of hydroxychloroquine and the resulting blood levels of the medication. Recent studies have shown that increased hydroxychloroquine levels are associated with lower lupus disease activity and likely also increased risk of medication toxicity.

Role of hydroxychloroquine in preconception period of recurrent miscarriage patients

“…Only 6% of patients exhibited deranged liver functions and 4% exhibited severe nausea, vomiting and were nontolerant to HCQ so, for such patients' treatment protocol was terminated and liver and other supportive treatments were given for recovery. The current study findings were similar to reports published by Chakrabarti et al and Huybrechts et al 10,11 It was observed from current study findings that out of 45 study participants who continued treatment protocol, 72% patients conceived, while remaining 18% patients did not conceive even after following treatment protocol for 6 months. Out of the 36 patients who conceived, 8 patients aborted in first trimester while the rest of patients continued with pregnancy till delivery.…”

“…The main therapeutic uses of HCQ includes: rheumatoid athritis (RA), malaria profylaxis and treatment, systemic and discoid lupus erythematosus (SLE). 10 Hydroxychloroquine is considered safe to be used in pregnant women and is widely used during pregnancy, specifically in patients with systemic lupus erythematous. 11 The therapeutic properties of HCQ like; anti thrombotic, vascular protective, immunomodulatory, improved glucose intolerance, lipid lowering and antiinfectious, could be beneficial and effective against some mechanisms of RPL with unidentified cause.…”

“…11 The therapeutic properties of HCQ like; anti thrombotic, vascular protective, immunomodulatory, improved glucose intolerance, lipid lowering and antiinfectious, could be beneficial and effective against some mechanisms of RPL with unidentified cause. [10][11][12][13][14] Additionally, convenient oral administration since the preconception period, low cost and minimal adverse event makes HCQ a possible treatment strategy for women with RPL.…”

Immunosuppression by hydroxychloroquine: mechanistic proof in in vitro experiments but limited systemic activity in a randomized placebo-controlled clinical pharmacology study

“…In combination with the observed variability of the endpoints, such effects remain easily undetected. However, whole blood concentrations are expected to be approximately 2-to-sevenfold higher than plasma concentrations due to intracellular uptake in blood components [ 38 – 40 ], which would make the concentrations more in range with the in vitro experiments. Also, due to the large volume of distribution [ 39 ] and the high HCQ tissue concentrations as compared to plasma [ 41 , 42 ], immunosuppressive effects in specific tissues may be significant.…”

Hydroxychloroquine Screening Guidelines: Best Evidence, Controversies, and Future Areas of Research

“…' HCQ Blood Levels in Patients and Correlations to RBW and IBW Dosing HCQ blood levels have been explored as a potential marker to help monitor disease activity, monitor adherence, achieve therapeutic levels of the medication, and minimize toxicity. 33,34 For example, studies have previously demonstrated that low whole-blood HCQ levels are associated with increased SLE disease activity (and vice versa) and are a strong predictor of disease exacerbation. 33,35 Low levels have also been associated with an increased risk of thrombotic events.…”