Effect of hydroxychloroquine dose reduction (2–3 mg/kg/day) on lipoprotein levels in stable lupus nephritis: A 12-month randomized controlled longitudinal study

ObjectiveTo evaluate whether hydroxychloroquine (HCQ) dose reduction (2-3 mg/kg/day) sustain lipoprotein levels achieved with higher doses of 2016-American Academy of Ophthalmology (2016-AAO) in stable lupus nephritis (LN) patients.MethodsForty-seven consecutive stable LN patients using HCQ 2016-AAO recommended dose for ≥6 months were enrolled and assigned to one of two groups: Reduced HCQ group (n = 21):LN patients who, upon inclusion, reduced 2016-AAO dose (2-3 mg/kg/day); and Maintenance HCQ group (<i>n</i> = 26):LN patients who continued on the standard 2016-AAO recommended HCQ dose (4.0-5.5 mg/kg actual body weight, maximum 400 mg/day) throughout 12-month study period. Blood HCQ levels, lipid profile and SLE parameters (including SLEDAI-2K) were assessed at baseline, 3 and 12-month.ResultsBaseline demographics, comorbidities and disease parameters were similar among groups (<i>p</i> > .05). Initial blood levels of Reduced HCQ group were 1219.4 (1041.7-1926.6)ng/mL and a progressive significant decrease were identified after 3 and 12 months [651.2 (538.4-832.6)vs.468.8 (228.4-925.6)ng/mL, <i>p</i> < .001]. Maintenance HCQ group had no changes in HCQ levels during the study [1179.7 (905.5-1607.3)vs.1026.2 (710.5-1345.8)vs.907.9 (663.9-1304.2)ng/mL, <i>p</i> = .158]. No changes were observed on the longitudinal total cholesterol levels of Reduced HCQ [166 (113-198)vs.153 (85-192)vs.150 (90-231)mg/dL, <i>p</i> = .964] and Maintenance HCQ [155 (114-244)vs.154 (122-210)vs.155 (112-213)mg/dL, <i>p</i> = .395]. LDL cholesterol levels of Reduced HCQ [91 (52-163)vs.83 (41-136vs.87 (47-165)mg/dL, <i>p</i> = .917] and Maintenance HCQ [79 (36-114)vs.76.5 (33-111)vs.75.5 (63-131)mg/dL, <i>p</i> = .412] remained similar. Other lipoprotein levels remained stable during 1 year of study.ConclusionThis is the first study to show that reducing HCQ to 2-3 mg/kg/day preserves lipid stability over 12 months in stable lupus nephritis patients.