HCQS advantageous in children with proliferative lupus nephritis

It is already known that Hydroxychloroquine (HCQ) is an antimalarial agent. It manages mucocutaneous, musculoskeletal, and constitutional manifestations of systemic lupus erythematosus (SLE). There is a lack of data elucidating its side effects in children with a history of proliferative lupus nephritis (LN).

Considering this background, a study was conducted on 60 children with a history of proliferative LN classes III and IV treated with steroids and mycophenolate (MMF) regimens.

The study points could be summarised as follows:

• The study had two groups: the HCQ and the placebo groups.
• The HCQ group had 30 patients, and the placebo also had 30 patients.
• They were evaluated initially at 6- and a 12-month follow-up by mucocutaneous, ophthalmological examination.
• During the follow-up period, investigations were carried out on BUN, creatinine, 24 h proteinuria, triglycerides (TG), cholesterol, Antids-DNA, C3, and C4.
• SLE disease activity index (SLEDAI-2 k) was used.
• In the HCQ group, after 12 months, there was a significant decrease in Triglycerides, cholesterol, 24 h proteinuria, Antids-DNA, and SLEDAI score.
• The cumulative probabilities of developing primary end-points (LN partial and complete remission) were 40% and 60% in the HCQ group versus 53.3% and 36.7% in the placebo after 12 months.
• After 12 months, the HCQ group experienced mucocutaneous alopecia (3.3%), hyperpigmentation (10%), and ophthalmological mild retinal changes (6.7%), but they did not differ significantly from the placebo group.

The researchers said we demonstrated the percentage of patients LN class III, class IV, and IV-V. as 54 %, 43 % and 3 %, respectively. As shown by LEVY et al., classes III and IV were the most common.

They mentioned the complications of HCQ as mucocutaneous, involving alopecia 3.3%, hyperpigmentation 10%, and ophthalmological 7%.

This study has demonstrated the efficacy of HCQ in children with a history of proliferative LN, having advantages like rapid and sustained remission, antilipidemic effect, and rapid improvement of functions of the kidney. The side effects are fewer, like the pigmentation of skin and retinopathy.

Considering this, researchers have highly pointed out the importance of ophthalmological screening.

The study's limitations include small sample size, short flow-up duration, and non-monitoring of the cumulative doses of HCQ and serum levels.

Further reading:

Gheet, F.S., Dawoud, H.ES., El-Shahaby, W.A. et al. Hydroxychloroquine in children with proliferative lupus nephritis: a randomized clinical trial. Eur J Pediatr (2023). https://doi.org/10.1007/s00431-023-04837-0