Early HCQ treatment prevents progression of CLE to SLE

Early initiation of hydroxychloroquine (HCQ) protects patients with cutaneous lupus erythematosus (CLE) from progressing to systemic lupus erythematosus (SLE), a recent study has shown.

“The progression from CLE to SLE remains a significant clinical challenge, with identified risk factors but no established preventative strategies,” the authors said.

This longitudinal study included 286 consecutive patients with isolated CLE (full study cohort) to determine whether early HCQ initiation reduces the risk of CLE progressing to SLE. Of the participants, 186 were treated with HCQ and 100 with topical corticosteroids/calcineurin inhibitors.

Progression to SLE was defined using the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria.

Fewer patients in the HCQ vs topical corticosteroids/topical inhibitors group progressed to SLE (4.8 percent vs 27 percent; p<0.001). Early HCQ initiation resulted in an 87-percent decrease in SLE risk over time (hazard ratio, 0.13, 95 percent confidence interval [CI], 0.06‒0.27; p<0.001), consistent across CLE severity levels and both positive and negative baseline antinuclear antibody titres.

In addition, severe SLE with end-organ involvement occurred less frequently in the HCQ group (risk ratio, 0.16, 95 percent CI, 0.19‒0.86; p=0.003).

“Early HCQ treatment demonstrated protective effects against progression to SLE, supporting its use as a preferred strategy in managing CLE to prevent systemic involvement,” the authors said.

The study was limited by its observational design, according to the authors.