EFFECTIVENESS OF HYDROXYCHLOROQUINE IN NON-CHINESE PATIENTS WITH IGA NEPHROPATHY

 

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https://storage.unitedwebnetwork.com/files/1099/0496e6d53feafdaaafadbe99bdffaf37.pdf
EFFECTIVENESS OF HYDROXYCHLOROQUINE IN NON-CHINESE PATIENTS WITH IGA NEPHROPATHY

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Jenny
Ng
Jenny Ng jenny.ng@sunnybrook.ca Sunnybrook Health Sciences Centre Department of Pharmacy, Division of Nephrology Toronto Canada *
Brandi Grozell brandi.grozell@sunnybrook.ca Sunnybrook Health Sciences Centre Division of Nephrology Toronto Canada -
Kevin Yau Kevin.Yau@uhn.ca University Health Network Division of Nephrology, Department of Medicine, University of Toronto Toronto Canada -
Michelle Hladunewich michelle.hladunewich@sunnybrook.ca Sunnybrook Health Sciences Centre Division of Nephrology, Department of Medicine, University of Toronto Toronto Canada -
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Hydroxychloroquine (HCQ) has been reported to be effective in lowering urinary protein in Chinese patients with IgA nephropathy (IgAN).1 2  In a randomized placebo controlled trial by Li et al. evaluating HCQ versus placebo in Asian patients with proteinuria of 0.75–3.5 g/d despite optimized renin-angiotensin-aldosterone system (RAAS) inhibitor therapy, proteinuria was reduced by 48% vs 10% in the placebo group at 6 months.3  However, there has been limited reports of the effectiveness of HCQ in other patient populations.  The 2025 Kidney Disease Improving Global Outcomes (KDIGO) guidelines for IgAN indicate that HCQ can be considered for Chinese patients who are at high risk of progression despite optimal supportive care, but indicated that there is  insufficient evidence for use in non-Chinese patients.4

We conducted a retrospective observational analysis of non-Chinese patients with biopsy proven IgAN on maximal conservative therapy, initiated on HCQ at a single center. The primary outcome was reduction in urine albumin to creatinine ratio (UACR) at 6 months.

The study cohort consisted of 32 non-Chinese patients initiated on HCQ during the evaluation period between January 2021 to January 2025, with a mean age of 42, 72% were female, 63% were Caucasian and 28% were South East Asian.  Patients had a mean baseline eGFR of 51 ml/min/1.73m2 and a median UACR of 139 mg/mmol. At 6 months from HCQ initiation, patients had a mean decrease in UACR of 50 mg/mmol. Three patients (9%) achieved complete remission (urine ACR <30 mg/mmol), 3 patients (9%) achieved partial remission (ACR < 60 mg/mmol) and an additional 3 patients (9%) had > 50% reduction in UACR.  HCQ was well tolerated with no adverse events reported.

In this single center study, HCQ was well tolerated and effective in lowering proteinuria at 6 months in 28% of non-Chinese patients.  Further prospective research in diverse populations and evaluation of ethnicities that may benefit most from HCQ is warranted.

Kewords