Yang Ting, Shi Yaotong, Wang Ye, Feng Yuan, Shao Qiuyuan, Jiang Chunming, Wang Lulu, Liu Jing
Department of Nephrology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China.
Department of Pharmacy, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China.
J Nephrol. 2024 Nov;37(8):2201-2208. doi: 10.1007/s40620-024-02029-z. Epub 2024 Jul 24.
Hydroxychloroquine (HCQ) is recommended for Chinese patients with immunoglobulin A nephropathy (IgAN). However, the relationship between HCQ blood concentration and the therapeutic effect for IgAN has not yet been defined. This study investigates the optimal and efficacious range of HCQ blood concentrations in Chinese patients with IgAN.
Seventy-three patients with biopsy-proven IgAN who were at risk of progression were included in this study. Thirty-eight patients with IgAN were treated with HCQ plus an optimized renin-angiotensin-aldosterone system inhibitor (RAASi), and thirty-five patients received only RAASi. Blood HCQ concentration and 24-h proteinuria were examined at three and six months after treatment.
The baseline proteinuria levels were comparable between the RAASi and HCQ groups. The HCQ group had lower 24-h proteinuria than the RAASi group three months after treatment, though the difference was not significant (p = 0.38). After six months, the median proteinuria level was significantly lower in the HCQ group than in the RAASi group (p < 0.05). The percentage reduction in 24-h proteinuria in the HCQ group was greater than that in the RAASi group at three (p < 0.05) and six months (p < 0.05). Hydroxychlorquine blood concentration and efficacy were positively correlated at three months (r = 0.428, p < 0.05) and six months (r = 0.48, p < 0.05). Moreover, the optimal blood concentration of HCQ for three-month efficacy was 418.96 ng/mL and that for six-month efficacy was 582.48 ng/mL. No serious adverse events were reported during HCQ treatment.
Hydroxyhloroquine safely reduces proteinuria in Chinese patients with IgAN. The efficacy of HCQ is positively correlated with its blood concentration.
羟氯喹（HCQ）被推荐用于中国免疫球蛋白A肾病（IgAN）患者。然而，HCQ血药浓度与IgAN治疗效果之间的关系尚未明确。本研究调查中国IgAN患者中HCQ血药浓度的最佳有效范围。
本研究纳入73例经活检证实有病情进展风险的IgAN患者。38例IgAN患者接受HCQ加优化的肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗，35例患者仅接受RAASi治疗。治疗后3个月和6个月检测血HCQ浓度和24小时蛋白尿。
RAASi组和HCQ组的基线蛋白尿水平相当。治疗3个月后，HCQ组的24小时蛋白尿低于RAASi组，尽管差异不显著（p = 0.38）。6个月后，HCQ组的蛋白尿中位数水平显著低于RAASi组（p < 0.05）。HCQ组24小时蛋白尿的降低百分比在3个月（p < 0.05）和6个月（p < 0.05）时均大于RAASi组。HCQ血药浓度与疗效在3个月（r = 0.428，p < 0.05）和6个月（r = 0.48，p < 0.05）时呈正相关。此外，3个月疗效的HCQ最佳血药浓度为418.96 ng/mL，6个月疗效的为582.48 ng/mL。HCQ治疗期间未报告严重不良事件。
羟氯喹可安全降低中国IgAN患者的蛋白尿。HCQ的疗效与其血药浓度呈正相关。
