Iudici M, Pantano I, Fasano S, Pierro L, Charlier B, Pingeon M, Dal Piaz F, Filippelli A, Izzo V
1 Rheumatology Section, Department of Clinical and Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
2 Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy.
Lupus. 2018 Feb;27(2):265-272. doi: 10.1177/0961203317717631. Epub 2017 Jun 28.
Background/objective The objectives of this paper are to assess the extent of and the factors associated with hydroxychloroquine (HCQ) non-adherence in systemic lupus erythematosus (SLE) patients with prolonged inactive disease and to investigate relationships between blood HCQ concentration and quality of life (QoL). Methods Consecutive SLE patients, in remission for at least one year and taking a stable dose of HCQ were investigated. At study entry (T0) and six months later (T6) a blood venous sample was taken to measure whole blood concentration of [HCQ] and desethylchloroquine ([DCQ]). Moreover, at T0 each patient completed validated questionnaires assessing QoL, disability, anxiety, depression and visual analogue scales for fatigue, pain, general health (GH), and self-assessment of disease activity. Results Eighty-three patients with a median [HCQ] of 327 ng/ml were enrolled. At T0, 24 (29%) were defined as non-adherent ([HCQ] < 100 ng/ml). At multiple logistic regression analysis the physical summary of SF-36 ( p = 0.038), and the concomitant use of immunosuppressants ( p = 0.010) were independently associated with non-adherence. A significant increase of HCQ adherence was observed at T6 ( p < 0.05). Conclusions A better health status and the concomitant prescription of immunosuppressants represent risk factors for HCQ non-adherence in SLE patients in remission. Monitoring HCQ levels might represent an important opportunity to improve adherence.
背景/目的 本文的目的是评估系统性红斑狼疮（SLE）长期无活动疾病患者中羟氯喹（HCQ）不依从的程度及相关因素，并研究血液中HCQ浓度与生活质量（QoL）之间的关系。方法 对连续的SLE患者进行研究，这些患者至少已缓解一年且服用稳定剂量的HCQ。在研究开始时（T0）和六个月后（T6）采集静脉血样，以测量全血中[HCQ]和去乙基氯喹（[DCQ]）的浓度。此外，在T0时，每位患者完成经过验证的问卷，评估生活质量、残疾、焦虑、抑郁以及疲劳、疼痛、总体健康（GH）的视觉模拟量表和疾病活动自我评估。结果 纳入了83例患者，[HCQ]中位数为327 ng/ml。在T0时，24例（29%）被定义为不依从（[HCQ]<100 ng/ml）。在多因素逻辑回归分析中，SF-36的身体总结（p = 0.038）和免疫抑制剂的同时使用（p = 0.010）与不依从独立相关。在T6时观察到HCQ依从性显著增加（p<0.05）。结论 更好的健康状况和免疫抑制剂的同时处方是缓解期SLE患者HCQ不依从的危险因素。监测HCQ水平可能是提高依从性的重要契机。
