LFA, WI Chapter is committed to funding local research that increases our understanding of lupus and leads to better treatments and outcomes for the estimated 5 million people worldwide who suffer from this mysterious, cruel disease. In 2023, the LFA, WI Chapter Board of Directors worked with Chapter staff and its Medical Advisory Committee to release a state-side request for applications for funding for basic or clinical lupus research.

That grant was awarded to Dr. Shivani Garg for the study Ensure Medication Safety & Efficacy by Targeted Hydroxychloroquine (HCQ) Level Monitoring (EMS-HCQ). This study brings together Wisconsin lupus researchers from both Madison and Milwaukee in investigative and advisory roles and aims to better understand and improve the role of HCQ in lupus treatment. 

To learn more about this study, read the abstract below.

Abstract: 

Lupus is a leading cause of early death and kidney failure that can be prevented by improving adherence to hydroxychloroquine (HCQ). A common patient-reported reason for stopping HCQ is the fear of rare eye toxicity. To elaborate, lupus is a leading cause of kidney failure and HCQ is cleared by the kidneys. Thus, kidney disease can potentially increase HCQ blood levels risking toxicity. Yet, current guidelines do not recommend adjusting HCQ doses in patients with kidney disease. This multiplies patient’s fears for toxicity leading to quitting HCQ. Moreover, HCQ can take months to show response, thus more patients stop HCQ in the absence of early improvement. HCQ nonadherence leads to 8-fold higher mortality and is a critical gap that can be addressed by developing an HCQ level monitoring intervention to personalize HCQ dosing to encourage safe and effective HCQ use in lupus. 

We will enroll 80 patients from Wisconsin’s dedicated lupus clinics in Madison. We will measure HCQ levels, kidney function, patient-reported symptoms over 24 months. We will examine how kidney function decline predicts toxic HCQ levels and define an ideal HCQ level threshold to improve patient-reported outcomes. Additionally, we will engage patient, payer, and clinician representatives to gather opinions regarding HCQ level monitoring to inform an intervention. This study will deliver an innovative strategy to implement HCQ level testing in clinics to tailor HCQ dosing to maximize use, ensure safety, and alleviate patient worry; promising a sustained positive impact on the health and survival of millions living with lupus.