SAT0188 WHOLE BLOOD VERSUS SERUM HYDROXYCHLOROQUINE LEVELS FOR DRUG MONITORING OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: PRELIMINARY RESULTS OF A PHARMACOLOGICAL STUDY

Background: In order to assess the pharmacokinetic/pharmacodynamic relationship of hydroxychloroquine (HCQ) in patients with systemic lupus erythematosus (SLE), HCQ levels have been measured in whole blood as well as in serum but both methods have never been compared. In addition, cut offs for non-adherence (classically 200ng/ml but also 100 ng/mL) have been established only in whole blood. Objectives: The aims of this study were (1) to compare these two pharmacological approaches, and (2) since it would be very interesting to retrospectively assess severe non-adherence in clinical trials or in large cohort of patients in which only serum samples are usually available, to determine if serum HCQ level cut offs could be established for identification of severe non-adherent patients. Methods: The HCQ and desethylchloroquine (DCQ) levels were measured in serum and whole blood from 573 SLE patients. The risk factors for active SLE (SLEDAI score >4) were identified using multiple logistic regression. HCQ serum level was also measured in 51 non-adherent patients (whole blood HCQ level Results: The mean HCQ and DCQ levels were 916 ± 449 and 116 ± 55 ng/mL in whole blood, respectively; and 469 ± 223 and 63 ± 31 ng/mL in serum, respectively. The mean ratio of serum/whole blood level for HCQ and DCQ were 0.53 ± 0.15 and 0.57 ± 0.21, respectively. A strong positive correlation was found between serum and whole blood levels of HCQ (rho=0.837 [CI95% 0.810-0.860], p Given the mean ratio of serum/whole blood level for HCQ was 0.53, we extrapolated that serum HCQ level cut offs of 106 and 53 ng/mL would correspond to the previously used cut-off of 200 and 100 ng/mL of HCQ in whole blood. Using HCQ serum level cut off of 106 ng/mL, 43 of 51 patients (84%) with blood HCQ levels Of these 51 patients, 25 patients (49%) exhibited HCQ whole blood concentration below 100 ng/mL. Using HCQ serum level cut off of 53 ng/mL, 23 of 25 patients (92%) with HCQ whole blood level Conclusion: Our data support the use of whole blood rather than serum as the matrix for drug monitoring of HCQ levels in SLE patients. However, when whole blood is not available, our results support the use of HCQ serum level to assess non-adherence with a cut off of 106 ng/mL corresponding to 200 ng/ml in whole blood. Disclosure of Interests: None declared