Application and safety of hydroxychloroquine sulfate in rheumatic diseases:a multicenter retrospective study in Suzhou / 中国实用内科杂志

ABSTRACT

OBJECTIVE: A multicenter survey is conducted to study the application,the long-term effect and safety of hydroxychloroquine(HCQ)in the treatment of rheumatic diseases in Suzhou. METHODS: Retrospectively collect the data of outpatients and inpatients from Rheumatology Department of four general hospitals in Suzhou(the First Affiliated Hospital of Suzhou University, and Suzhou Hospital of Traditional Chinese Medicine, the First People's Hospital of Kunshan, the First People's Hospital of Changshu)from June 2017 to July 2018. A special questionnaire was used to collect data on general information, diagnosis, methods and courses in the use of hydroxychloro-quine, duration, efficacy and compliance, combined medication, adverse reactions of ophthalmology and other systems, and the use of hydroxychloroquine(HCQ)during pregnancy.Result Totally there were 856 cases, including 68 males(7.9%)and 788 females(92.1%).Classification of diseases 147 cases of RA(including secondary SS of RA), 425 cases of SLE,12 cases of APS, 167 cases of PSS,104 cases of others, and 1 case of overlap syndrome(RA with SLE)The treatment course of HCQ minimum 0.5 years, maximum 22.75 years, with an average of 3.59(SD=3.08)years.Dosage 0.2 g/day in 604 cases, 0.4 g/day in 424 cases, 193 cases of using 0.4 and 0.2 successively, and 21 in other cases;721 cases used continuously. There were adverse reactions in 183 cases(7 males and 176 females), which were distributed in 30 cases of RA, 105 cases of SLE, 2 cases of APS, 31 cases of SS and 15 other cases. Ophthalmological adverse reactions occurred in 70 cases, with positive correlation in 4 cases. Ophthalmological examination 121 cases(14.1%)every year;68 cases(7.9%)every two years. There were 92 cases of adverse skin reactions, with 8 cases of positive correlation. Other systems had few adverse reactions and there was no positive correlation. Continuous medication, combination of anti-rheumatic drugs and adverse reactions were associated, and continuous medication or combination of anti-rheumatic drugs were significantly associated with adverse reactions in ophthalmology and skin, respectively. The adverse reactions of ophthalmology were related to the course of treatment, and the adverse reactions of fundus increased after taking medicine for more than 7 years.There were 37 pregnancies and HCQ was used in 17 cases throughout pregnancy, and only 1 case had non-drug-related neonatal defects. CONCLUSION: HCQ is mainly used in the treatment of SLE, SS, RA and APS in Rheumatology Department in Suzhou. HCQ medication is standardized, but ophthalmic follow-up monitoring is not. Adverse reactions are mainly in skin and ophthalmology. Continuous medication and combination of antirheumatic drugs are associated factors of adverse reactions.Long-term treatment with HCQ is safe and well-toleratrd.