Prescribing Patterns of Hydroxychloroquine and Glucocorticoids Among Lupus Patients After New‐Onset End‐Stage Renal Disease

Abstract

Objective. Optimal strategies for managing lupus medications after end-stage renal disease (ESRD) have not been addressed. The objective was to identify the current US-wide prescribing patterns of hydroxychloroquine (HCQ) and oral glucocorticoids (GS) among systemic lupus erythematosus (SLE) patients with incident ESRD enrolled in the US Renal Data System (USRDS) registry.Methods. We identified incident ESRD patients age ≥18 years with SLE as a primary cause of ESRD between January 2006 and June 2013. Patients who were started on dialysis at ESRD onset and enrolled in Medicare Part D within 93 days as required by Medicare were included.Results. Among the 2,654 new-onset ESRD patients with Part D, the median duration of follow-up was 761 days (interquartile range [IQR] 374-1,375). At baseline, 1,076 patients (41%) were not receiving HCQ or GS, 220 (8%) were prescribed HCQ alone, 509 (19%) were prescribed both HCQ and GS, and 849 (32%) were prescribed GS alone. Of the 1,983 patients who either never received or discontinued HCQ after ESRD onset, 667 (34%) continued GS to the end of the follow-up period. The median GS dose was lower for patients taking HCQ (14 mg [IQR 9-21]) compared to patients who were never prescribed HCQ (15 mg ) or patients who discontinued HCQ after ; P = 0.001).Conclusion. Approximately one-third of patients with lupus nephritis and new-onset ESRD received GS monotherapy at high doses. As GS-related complications contribute to hospitalizations and deaths in SLE ESRD, changing these prescribing practices may improve morbidity and mortality outcomes.

Hydroxychloroquine induces apoptosis of myeloid-derived suppressor cells via up-regulation of CD81 contributing to alleviate lupus symptoms

“…Hydroxychloroquine (HCQ), belongs to the 4­aminoquinolines class with antimalarial activity and an immunomodulatory effect (Schrezenmeier and Dörner 2020 ; Munguía-Realpozo et al, 2021 ; Gupta et al 2022 ). It has also been used clinically in the treatment of systemic lupus erythematosus (SLE) (Costedoat-Chalumeau et al 2014 ; Broder et al 2021 ), downregulating pro-inflammatory cytokines and immunoglobulin, eliminating autoreactive lymphocytes, ultimately improves patient survival and relieves severe lupus symptoms (Takamasu et al 2019 ; Ponticelli and Moroni 2017 ; Willis et al 2012 ; Rainsford et al 2015 ). Some studies have shown that HCQ mainly accumulates in acidic vesicular lysosomes, affects the functions of proteasomes by increasing intracellular vacuolar pH, and also inhibits the functions of endolysosomes regulating autophagy, calcium signaling, and toll-like receptor (TLR)-mediated immune responses (Wu et al 2017 ; Wallace et al 2012 ; Nirk et al 2020 ).…”