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Alle, Gelsomina; Guettrot-Imbert, Gaëlle; Larosa, Maddalena; Murarasu, Anne; Lazaro, Estibaliz; Morel, Nathalie; Orquevaux, Pauline; Sailler, Laurent; Queyrel, Viviane; Hachulla, Eric; Sarrot Reynauld, Françoise; Pérard, Laurent; Bérezné, Alice; Morati-Hafsaoui, Chafika; Chauvet, Elodie; Richez, Christophe; Goulenok, Tiphaine; London, Jonathan; Molto, Anna; Urbanski, Geoffrey; Le Besnerais, Maëlle; Langlois, Vincent; Leroux, Gaëlle; Souchaud-Debouverie, Odile; [...]

Hydroxychloroquine levels in pregnancy and materno-fetal outcomes in systemic lupus erythematosus patients

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  • Medientyp: E-Artikel
  • Titel: Hydroxychloroquine levels in pregnancy and materno-fetal outcomes in systemic lupus erythematosus patients
  • Beteiligte: Alle, Gelsomina; Guettrot-Imbert, Gaëlle; Larosa, Maddalena; Murarasu, Anne; Lazaro, Estibaliz; Morel, Nathalie; Orquevaux, Pauline; Sailler, Laurent; Queyrel, Viviane; Hachulla, Eric; Sarrot Reynauld, Françoise; Pérard, Laurent; Bérezné, Alice; Morati-Hafsaoui, Chafika; Chauvet, Elodie; Richez, Christophe; Goulenok, Tiphaine; London, Jonathan; Molto, Anna; Urbanski, Geoffrey; Le Besnerais, Maëlle; Langlois, Vincent; Leroux, Gaëlle; Souchaud-Debouverie, Odile; [...]
  • Erschienen: Oxford University Press (OUP), 2024
  • Erschienen in: Rheumatology (2024)
  • Sprache: Englisch
  • DOI: 10.1093/rheumatology/keae302
  • ISSN: 1462-0332; 1462-0324
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: Abstract Objectives Data about hydroxychloroquine (HCQ) levels during pregnancy are sparse. We assessed HCQ whole-blood levels at first trimester of pregnancy as a potential predictor of maternal and obstetric/fetal outcomes in patients with systemic lupus erythematosus (SLE). Methods We included pregnant SLE patients enrolled in the prospective GR2 study receiving HCQ, with at least one available first-trimester whole-blood HCQ assay. We evaluated several cut-offs for HCQ whole-blood levels, including ≤200 ng/ml for severe non-adherence. Primary outcomes were maternal flares during the second and third trimesters of pregnancy, and adverse pregnancy outcomes (APOs: fetal/neonatal death, placental insufficiency with preterm delivery, and small-for-gestational-age neonates). Results We included 174 patients (median age: 32.1 years, IQR 28.8–35.2). Thirty (17.2%) patients had flares, four (2.3%) being severe. APOs occurred in 28 patients (16.1%). There were no significant differences in APOs by HCQ level for either those with subtherapeutic HCQ levels (≤500 ng/ml vs >500 ng/ml: 23.5% vs 14.3%, P = 0.19) or those with non-adherent HCQ levels (≤200 ng/ml vs >200 ng/ml: 20.0% vs 15.7%, P = 0.71). Similarly, the overall rate of maternal flares did not differ significantly by HCQ level cut-off, but patients with subtherapeutic (HCQ ≤500 ng/ml: 8.8% vs 0.7%, P = 0.02) and non-adherent HCQ levels (≤200 ng/ml: 13.3% vs 1.3%, P = 0.04) had significantly more severe flares. 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. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT02450396