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Hydroxychloroquine dosing in systemic lupus erythematosus: response to ‘Letter in response to the 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus by Fanouriakis et al’ by Costedoat-Chalumeau et al
  1. Antonis Fanouriakis1,
  2. George Bertsias2,3,
  3. Dimitrios T Boumpas1,4,5
  1. 1 Rheumatology and Clinical Immunology, 4th Department of Internal Medicine, "Attikon" University Hospital, Athens, Greece
  2. 2 Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece
  3. 3 Laboratory of Autoimmunity-Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Greece
  4. 4 Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
  5. 5 Joint Academic Rheumatology Program, Medical School, National and Kapodestrian University of Athens, Athens, Greece
  1. Correspondence to Dr Dimitrios T Boumpas, Medicine, National and Kapodestrian University of Athens, 12462 Athens, Greece; boumpasd{at}

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We thank Drs Costedoat-Chalumeau, Isenberg and Petri for their interest and insightful comments regarding hydroxychloroquine (HCQ) dosing in systemic lupus erythematosus (SLE).1 The authors outline three major arguments against recommending a lower daily dose for HCQ: (1) the lower dose of 5 mg/kg real weight/day has not proven equal efficacy with the previous 6.5 mg/kg/day, (2) the patient population of the studies that suggest higher rates of HCQ-retinopathy (older patients, mostly with rheumatoid arthritis) does not correspond to the average patient with lupus and (3) established low adherence rates to HCQ reported in some studies, if combined with a lower prescribed dose, may potentially lead to HCQ …

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