More than 1 in 1000 Canadians are affected by systemic lupus erythematosus, a chronic autoimmune disease characterized by more or less acute episodes of inflammation and periods of remission. The regular course of treatment is hydroxychloroquine (HCQ), whose ongoing use can alleviate symptoms. The relief, however, can bring its crop of side-effects, including visual difficulties that cause some patients to reduce and even stop the treatment. Dr. Sasha Bernatsky, senior researcher at the Research Institute of the McGill University Health Centre, set out to provide better care for lupus patients by determining the demographic and clinical factors associated with negative effects in the individuals who reduce or stop their HCQ treatment.
With her team, she followed nearly 1 400 Canadians with lupus from 1999 to 2019. Participants were divided into three groups: those who followed standard HCQ treatment, those whose HCQ treatment was reduced and those who stopped taking HCQ altogether. The experts found that non-Caucasian individuals who were diagnosed with lupus at the age of 25 or younger and patients experiencing an episode of inflammation do not benefit from stopping the treatment. The same was found to be true for the concurrent use of immunosuppressants, which is linked to less control of the disease.
Published in Arthritis Care & Research, the results pave the way for personalized lupus treatment. Indeed, society as a whole would benefit from better lupus management. Currently, lupus patients who lose control of the disease are often hospitalized—a situation that can lead to organ failure in the long term. When the kidneys are affected, patients are forced to consider costly treatment options such as dialysis or transplant. In some cases, those affected by lupus become so disabled that they require continuing care.