Effects of Stopping Hydroxychloroquine in Elderly Lupus Disease

Recruiting now · Phase 3 · Has a placebo group

Conditions studied: Systemic Lupus Erythematosus

In brief

Hydroxychloroquine (HCQ) is a systemic lupus erythematosus (SLE) medication that has been very effective in reducing lupus disease activity and keeping patients stable with reduced symptoms. Despite a track record of safety with regard to infection compared to traditional immunosuppressive agents, the risk of HCQ retinal toxicity escalates with continued use. Evaluation using sensitive standard of care approaches suggests nearly a third of patients accrue retinal damage. Data are needed to accurately weigh the balance between accumulating ocular exposure of HCQ versus the risk of disease flare in a population that may have more inactive disease than younger patients. The purpose of this trial is to address the safety of withdrawal of HCQ in SLE patients =60 years old. The central hypothesis is that HCQ can be safely discontinued in stable/quiescent patients assessed by validated disease activity and flare instruments in the context of serologic, cytokine and transcriptomic profiling. Patients will be randomized to either the placebo or active arm and followed every 3 months for one year to assess disease activity and flares.

Key facts

Study ID

NCT05799378

Run by

NYU Langone Health

People needed

330

Starts

2024-06-27

Expected to finish

2029-06-30

Last updated by the study team

2026-08-05

Who can join

Age: 55 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Provision of signed and dated informed consent form
• Stated willingness to comply with all study procedures and availability for the duration of the study
• Age ≥ 60 years at time of enrollment
• Normal OCT and VF assessment within 6 months of screening visit
• Ability to take oral medication
• Have established SLE (≥ 4 ACR criteria or SLICC criteria or ≥ 10 points by EULAR criteria, SLE diagnosed at least seven years ago)
• Stable disease at screening visit by attaining DORIS remission (meeting all criterion listed below) and not on any immunosuppressants.
• Criterion 1: Clinical SLEDAI= 0
• Criterion 2: SELENA-SLEDAI PGA ≤ 0.5 (on a scale from 0-3, where 0 is no disease activity and 3 is maximum disease activity)
• Criterion 3: Current prednisolone (or equivalent corticosteroid) dose ≤ 5 mg daily
• No moderate or severe flares one year prior to screening
• Taking ≥ 200 HCQ daily for ≥ 7 years

You may not qualify if…

• Any patient that does not attain stable disease status by DORIS
• Ophthalmologic evidence of retinopathy (these patients would be advised to discontinue HCQ and therefore unethical to randomize for this study)
• Clinical SLEDAI > 0
• Taking > 5 mg/day prednisone
• Taking any immunosuppressive drugs or biological agents (including: methotrexate, azathioprine, mycophenolate mofetil, mycophenolic acid, leflunomide, cyclosporine, cyclophosphamide, tacrolimus, rituximab, and belimumab)
• Any reason the treating rheumatologist is concerned about ongoing activity not captured by SLEDAI
• HCQ level < 100 ng/ml as this would support noncompliance and less reliance on HCQ to control activity
• Patient unwilling or unable to comply with study procedures for any reason
• Any indications of potentially diminished capacity, such as a diagnosis of dementia or cognitive impairment (including, but not limited to stroke-related cognitive impairment)

Where it is running

• Penn State MS Hershey Medical Center — Hershey, Pennsylvania, United States (enrolling)
• University of California: San Diego — San Diego, California, United States (enrolling)
• Emory University School of Medicine — Atlanta, Georgia, United States (enrolling)
• Hackensack Meridian Health — Hackensack, New Jersey, United States (enrolling)
• VA NY Harbor Healthcare System — New York, New York, United States (enrolling)
• NYC Health + Hospitals/Bellevue — New York, New York, United States (enrolling)
• NYU Langone Health — New York, New York, United States (enrolling)
• Hospital for Special Surgery — New York, New York, United States (enrolling)
• Columbia University Irving Medical Center/New York Presbyterian — New York, New York, United States (enrolling)
• University of California, Los Angeles — Los Angeles, California, United States (enrolling)
• Oklahoma Medical Research Foundation — Oklahoma City, Oklahoma, United States (enrolling)
• Montefiore Medical Center/Albert Einstein College of Medicine — The Bronx, New York, United States

Full record on ClinicalTrials.gov

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