Early initiation of hydroxychloroquine in cutaneous lupus erythematosus to prevent progression to systemic lupus erythematosus: A long-term follow-up study

Abstract

Background: The progression from cutaneous lupus erythematosus (CLE) to systemic lupus erythematosus (SLE) remains a significant clinical challenge, with identified risk factors but no established preventative strategies.

Objectives: To evaluate whether early hydroxychloroquine (HCQ) initiation reduces the risk of CLE progressing to SLE.

Methods: A longitudinal study of 286 consecutive patients with isolated CLE (full study cohort), treated with HCQ (n = 186) or topical corticosteroids/calcineurin inhibitors (n = 100). Progression to SLE was defined using the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria.

Results: Progression to SLE occurred in 4.8% of the HCQ group and 27% of the topical corticosteroids/topical inhibitors group (P < .001). Early initiation of HCQ was associated with an 87% reduction in SLE risk over time (hazard ratio: 0.13, 95% CI: 0.06-0.27, P < .001), consistent across all CLE severity levels and both positive and negative baseline antinuclear antibody titers. Severe SLE with end-organ involvement was also significantly less frequent in the HCQ group (risk ratio: 0.16, 95% CI: 0.19-0.86, P = .003).

Limitations: Observational design.

Conclusions: Early HCQ treatment demonstrated protective effects against progression to SLE, supporting its use as a preferred strategy in managing CLE to prevent systemic involvement.

Keywords: antimalarial herapy; autoimmune disorders; cutaneous lupus erythematosus; disease progression; hydroxychloroquine; systemic lupus erythematosus.