Lupus Foundation of America Hydroxychloroquine Survey Sheds Light on Need for New Dosage Forms
Hydroxychloroquine (Plaquenil®) is the most prescribed medication for symptoms of lupus. The drug is available in one strength (200 mg tablets). The Lupus Foundation of America conducted a survey to assess if availability of a single strength limited the flexibility and ability to accurately dose people with lupus. An online survey was fielded to people diagnosed with systemic lupus erythematosus (SLE). More than 3,100 people taking hydroxychloroquine (HCQ) responded to questions about their tolerance and adherence to the medication.
The most commonly reported daily dosages of HCQ were 400 mg (50%) and 200 mg (34%) while 13% of respondents reported taking 300 mg/day, either taking the drug on alternate days or splitting tablets. Overall, 26% were on doses exceeding the American Academy of Ophthalmology (AAO) recommendations (dosage calculated by a person’s weight). Additionally, respondents (56%) indicated experiencing gastrointestinal problems due to HCQ but only 15% of individuals told their doctor.
Respondents were asked questions about dosing regimens and taste. Thirty-two percent of respondents taking different alternate-day doses reported forgetting or mixing up their doses. Those who switched their doses daily were more likely to forget or mix up which dose they were supposed to take each day (compared to respondents who did not have complicated dose schedules). Additionally, 48% reported a bitter taste when taking HCQ. People who needed to split their tablets to get the correct dose were more likely to notice a bitter taste (compared to people who didn’t need to split the tablets).
"Lupus patients would benefit from more flexible hydroxychloroquine dosing options. This would improve adherence and diminish adverse reactions to the drug," said lead researcher, Daniel J. Wallace M.D., FACP, MACR, Associate Director, Rheumatology Fellowship Program, Board of Governors and Professor of Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine Center at UCLA.
The survey reveals an ongoing challenge in lupus treatment. Tailoring the optimal dosage regimen per individual is difficult and it is important to pay attention to dosing more so because of new AAO guidelines. Additionally, dosing strategies may have a negative impact on adherence. New dosage forms of HCQ would provide greater flexibility to accurately tailor doses for people with lupus. The Lupus Foundation of America will continue to monitor and report on HCQ dosing forms. Learn about hydroxychloroquine.