Lupus & antiphospholipid syndrome
Hydroxychloroquine levels in pregnancy and materno-fetal outcomes in systemic lupus erythematosus patients
Authors' conclusion
In this large prospective study of pregnant SLE patients, first-trimester subtherapeutic (≤500 ng/ml) and severe non-adherent (≤200 ng/ml) HCQ levels were associated with severe maternal flares, but not with APOs.
Study context
- Population
- Pregnant systemic lupus erythematosus (SLE) patients in the prospective GR2 study receiving hydroxychloroquine (HCQ), with ≥1 first-trimester whole-blood HCQ assaymedian age 32.1 years
- Participants
- 174 patients
- Exposure
- First-trimester HCQ whole-blood levels: subtherapeutic (≤500 ng/ml) vs >500 ng/ml; non-adherent (≤200 ng/ml) vs >200 ng/ml
- Outcome
- Maternal flares during 2nd and 3rd trimesters, and APOs (fetal/neonatal death, placental insufficiency with preterm delivery, small-for-gestational-age neonates)
Methodological detailssecondary analysis of the prospective GR2 study
- Secondary analysis of the prospective GR2 study
Main finding
As reported in the abstract
APOs by first-trimester HCQ level
HCQ ≤500 ng/ml vs HCQ >500 ng/ml: P = 0.19 · HCQ ≤200 ng/ml vs HCQ >200 ng/ml: P = 0.71
- APOs overall: 28 patients
- 16.1%
- Maternal flares overall: 30 patients
- 17.2%
Observational data: associations, not effects.
Further findings
Severe maternal flares by first-trimester HCQ level — HCQ ≤500 ng/ml vs HCQ >500 ng/ml
P = 0.02
| Outcome | P value |
|---|---|
| Severe maternal flares by first-trimester HCQ levelHCQ ≤200 ng/ml vs HCQ >200 ng/ml | P = 0.04 |
- Severe maternal flares by first-trimester HCQ level — Severe flares overall: 4 patients
- 2.3%
Original publication
Hydroxychloroquine levels in pregnancy and materno-fetal outcomes in systemic lupus erythematosus patients. Rheumatology (Oxford). Published 5 June 2024. doi:10.
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