Weighing the Dose: Hydroxychloroquine’s Risks and Rewards in Lupus Care
A large nationwide study from Taiwan provides new evidence on the long-term safety and effectiveness of hydroxychloroquine (HCQ) dosing in patients with systemic lupus erythematosus (SLE). Analyzing data from over 23,000 patients initiating HCQ between 2010 and 2021, researchers compared outcomes for those on a higher dose (≥400 mg/day) versus a lower dose (<400 mg/day). After statistical adjustment, the higher-dose strategy was associated with significantly lower risks of coronary artery disease and venous thromboembolism. Crucially, for patients under 45, there was no increased risk of the feared complication of HCQ retinopathy, though an elevated risk was noted in older patients.
Why it might matter to you: This research directly informs the complex risk-benefit calculus in managing chronic autoimmune conditions, a core challenge in hepatology when using immunosuppressants. The findings underscore the importance of precision in dosing, where a one-size-fits-all approach can miss opportunities to prevent major cardiovascular events. For clinicians, it reinforces the need for age-stratified monitoring protocols, particularly for drug-induced toxicities like retinopathy, which parallels the vigilance required for hepatotoxicity in liver disease management.
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