Article Text
Abstract
Gastric bypass surgery, also called Roux-en-Y gastric bypass (RYGB), can result in the malabsorption of medications, requiring the use of higher than usual doses in order to achieve a therapeutic effect. We describe the results of hydroxychloroquine (HCQ) blood levels in three patients with systemic autoimmune disease taking standard HCQ doses and their associated disease activity levels. This is a retrospective review of all patients who had undergone RYGB and were taking HCQ in a rheumatology community-based practice. Two patients with SLE and one patient with primary Sjogren’s syndrome had previously undergone RYGB. All three had subtherapeutic HCQ blood levels and active disease. Increasing their HCQ doses above the recommended 400 mg a day dosing resulted in therapeutic HCQ levels in all three patients and better disease control in two of the three patients. RYGB patients may not absorb HCQ adequately, resulting in subtherapeutic HCQ blood levels and inadequate disease control. Patients who have undergone RYGB and are taking HCQ should have drug levels monitored. RYGB patients may require higher than recommended doses of HCQ in order to achieve better disease control and avoid unneeded additional immunosuppressive agents.
- hydroxychloroquine
- lupus
- sjogren's
- gastric bypass
- plaquenil
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Footnotes
Contributors JL is an ophthalmologist who was one of the authors of the American Academy of Ophthalmology guidelines for hydroxychloroquine dosing and retinopathy screening. He assisted in supplying the comments and literature regarding the background for these recommendations and their potential shortcomings and how it pertains to the manuscript. BG is a bariatric surgeon. He assisted in supplying the comments and literature regarding the potential for the malabsorption of drugs in people who have undergone gastric bypass surgery. MP has written several papers regarding the utility of using hydroxychloroquine drug levels in the management of patients with lupus. She contributed comments and articles regarding the proper use of drug levels in these patients and how it could affect proper management of their connective tissue diseases.
Funding Exagen Diagnostics paid for part of the publication fee, otherwise, the authors received no financial support for the research, nor authorship.
Competing interests DET is on the Speakers’ Bureau for Exagen Diagnostics. Exagen Diagnostics performs laboratory testing for hydroxychloroquine drug levels.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No additional data are available.