羟氯喹在儿童患者的应用及其安全性观察

Application and safety of hydroxychloroquine in chronic disease among children

目的分析儿童使用羟氯喹的主要疾病谱,初步评价儿童使用该药物的安全性和依从性。方法以2008年1月至2019年12月在复旦大学附属儿科医院住院或出院后随访期间使用羟氯喹的528例患儿为研究对象,回顾性分析该药使用疾病谱,对其中持续使用羟氯喹超过3个月且随访超过6个月的患儿进行药物安全性及依从性评价。收集人口学信息、诊断、羟氯喹使用初始剂量、持续使用时间、累积使用剂量、相关不良反应报告,眼科检查项目与结果等资料进行分析。系统性红斑狼疮(SLE)与其他病种间持续使用时间和累积使用剂量的差异比较采用Mann-Whitney检验。结果12年共计528例患儿使用羟氯喹,其中男156例、女372例,初次用药年龄为(10.5±3.2)岁。其中风湿性疾病514例(97.4%),肺间质病变5例(0.9%)和其他系统疾病9例(1.7%)。风湿性疾病中前3位依次为SLE(316/514,61.5%),幼年型特发性关节炎(69/514,13.4%),幼年型皮肌炎(56/514,10.9%)。同期SLE诊断397例,羟氯喹使用比例最高(316/397,79.6%),且逐年增多。肺间质病变包括4例SFTPC基因缺陷相关间质性肺病。528例使用羟氯喹的患儿中397例纳入药物安全性及依从性分析,初始剂量为(4.2±1.0)mg/kg,持续使用时间为29.6(14.9,48.8)个月,最长者127个月,最大累积使用剂量为566.8 g。SLE患儿的持续使用时间(Z=-3.191,P=0.001)和累积使用剂量(Z=-5.355,P=0.001)均显著高于其他病种。所有随访患儿用药前均进行全面眼科检查,354例(89.2%)在本院眼科随访,其中65.5%(232/354)可达到每年1次及以上的定期随访。随访期间1例患儿在用药32.7个月时发生皮肤严重不良反应,无其他严重不良反应发生,无羟氯喹相关视网膜病发生,5例自行停药。结论羟氯喹主要用于SLE为主的儿童风湿性疾病中。长期使用安全性好,严重不良反应少;用药及眼科随访依从性好。

Objective To analyze the disease spectrum among children who were using hydroxychloroquine(HCQ),and evaluate the drug′s safety and compliance.Methods From January 2008 to December 2019,children from Children′s Hospital of Fudan University who used HCQ were selected as subjects,the disease spectrum of HCQ was analyzed,and the drug safety and compliance were evaluated for the patients who were followed up for more than 6 months.Demographic information,diagnosis,initial dose,time of continuous use,cumulative dosage and related adverse reactions report,project and the results of eye test were collected.Results A total of 528 cases used HCQ during the 12 years,with 156 male cases and 372 female cases,and age at initial medication was(10.5±3.2)years.Among them,514 cases(97.3%)had rheumatic disease,5 had pulmonary interstitial lesions and 9 had other system diseases.The top three of the rheumatic diseases were systemic lupus erythematosus(SLE)in 316 cases(316/514,61.5%),juvenile idiopathic arthritis in 69 cases(69/514,13.4%),and juvenile dermatomyositis in 56 cases(56/514,10.9%).During the same period,397 cases were diagnosed with SLE,and the utilization rate was 79.6%(316/397),which was the highest compared with other diseases and increased year by year.Pulmonary interstitial lesions included 4 cases with SFTPC gene defect related interstitial lung disease.Of the 528 ceses who were treated with HCQ,397 cases were included for evaluating HCQ′s safety and compliance,the initial dose was(4.2±1.0)mg/kg,duration was 29.6(14.9,48.8)months,the longest usage time was 127 months,the largest cumulative dosage was 566.8 g.The continuous usage duration(Z=-3.191,P=0.001)of SLE was significantly higher than those of other diseases,as well as cumulative dosage(Z=-5.355,P=0.001).All cases received comprehensive eye exams before medication,354 cases(354/397,89.2%)were followed up in the ophthalmological department,and 65.5%(232/354)of them could be reviewed regularly at least 1 time per year.One case suffered from severe skin adverse reactions when the drug was used for 32.7 months,and no other serious adverse reactions were reported.HCQ related retinopathy was not seen during the follow-up period.There were 5 cases stopped HCQ on their own.Conclusions HCQ was widely used in rheumatic disease in children,especially in those with SLE.It was safe for long-time usage in children,and the medication compliance and the ophthalmic follow-up was good.