Lupus & antiphospholipid syndrome
Increasing the utilisation of hydroxychloroquine blood level testing in lupus: a quality improvement project
Authors' conclusion
This real-world quality improvement initiative demonstrates both the feasibility and clinical yield of integrating HCQ monitoring into routine SLE care. Beyond increasing test utilisation, monitoring revealed a substantial burden of HCQ exposure below the therapeutic range that would have remained invisible without systematic testing.
Study context
- Population
- Adult patients with SLE at an academic medical centre, August 2024 to November 2025nearly 1000 adults with SLE
- Comparison
- Before vs after a multidisciplinary QI initiative
- Outcome
- Proportion of eligible patients with SLE with HCQ testing
Methodological detailssingle-centre, Plan-Do-Study-Act framework
- Single-centre
- Plan-Do-Study-Act framework
Main finding
As reported in the abstract
Proportion of patients with SLE with HCQ testing
- Absolute increase (percentage points)
- 11
- Relative increase
- more than threefold
Further findings
Provider adoption (rheumatologists ordering hydroxychloroquine (HCQ) testing)
- Increased from 24% (8/33) to 73% (24/33) of rheumatologists
HCQ level distribution among tested patients (secondary analysis; n=170)
- HCQ levels below the therapeutic range
- 79.4%
- Severe non-adherence (<200 ng/mL)
- 14.7%
- Severe non-adherence approximately twice that in published cohorts
Original publication
Increasing the utilisation of hydroxychloroquine blood level testing in lupus: a quality improvement project. Lupus Sci Med. Published 29 June 2026. doi:10.
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