TY - JOUR T1 - Dialogue: Hydroxychloroquine pharmacokinetic (PK) and exposure response in pregnancies with systemic lupus erythematosus: the importance of adherence for neonatal outcome JF - Lupus Science & Medicine JO - Lupus Sci Med DO - 10.1136/lupus-2021-000630 VL - 9 IS - 1 SP - e000630 AU - Bonnie Bermas AU - Nathalie Costedoat-Chalumeau Y1 - 2022/01/01 UR - http://lupus.bmj.com/content/9/1/e000630.abstract N2 - Hydroxychloroquine (HCQ) is the cornerstone of therapy for persons with SLE. Not only does it reduce morbidity and mortality, but also it improves maternal and fetal outcomes in pregnant women with SLE.1 In spite of these benefits, claims data studies show that HCQ medication adherence during pregnancy is low.2 Data suggest that measuring HCQ blood levels is an objective measure of non-adherence in patients with SLE.3 However, during pregnancy, it is possible changes in drug pharmacokinetics (PK) may impact drug exposure.In this issue of Lupus Science and Medicine, Balevic et al present data on significant changes in HCQ PK during pregnancy with a shortening of drug half-life by 10 days.4 However, the authors noted that this change in PK had less of an effect on HCQ exposure during pregnancy than medication adherence. Overall, low HCQ levels resulted in higher rates of preterm birth.The study evaluated serum levels of HCQ in 61 pregnancies in 56 women who were taking this medication a minimum of 3 months prior to pregnancy. Levels were defined as non-adherent ≤100 … ER -