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Objective We sought to determine the impact of hydroxychloroquine (HCQ) dose on the risk of hospitalizations for systemic lupus erythematosus (SLE). Methods We conducted a case‐crossover study within an academic health system, including patients with SLE who used HCQ and had ≥1 hospitalization for active SLE between January 2011 and December 2021. Case periods ended in hospitalization for SLE, whereas control periods did not. The exposures were the average weight‐based HCQ dose, categorized as ≤5 or >5 mg/kg/day, and non–weight‐based HCQ dose, categorized as 5 mg/kg/day) and non–weight‐based dose (<400 vs 400 mg/day) were each associated with increased hospitalizations for active SLE (adjusted OR 4.20, 95% confidence interval CI 1.45–12.19, and adjusted OR 3.39, 95% CI 1.31–8.81). Conclusion The use of lower doses of HCQ was associated with an increased risk of hospitalizations for active SLE. Although the long‐term risk of HCQ retinopathy must be acknowledged, this must be balanced with the short‐term and cumulative risks of increased SLE activity. image
Nestor et al. (Tue,) studied this question.