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Where do the above data leave us? Undoubtedly, HCQ is indispensable for the treatment of SLE, but a certain degree of caution is needed. The recommended daily dose should not exceed 5 mg/kg real body weight and periodic eye examination (baseline, after 5 years and yearly thereafter, in the absence of retinal findings) should no more be performed by funduscopy, rather by one of the newer screening techniques recommended by the American Academy of Ophthalmology.25 Of note, the comparative efficacy of lower HCQ doses in terms of disease control and prevention of relapses will have to be tested in practice, as all published trials have used the previously common 6.5 mg/kg target dose. In our practice, we also attempt to reduce to a maintenance dose of 200 mg/day in patients with persistent low disease activity (LDA) or remission, although no robust data exist to substantiate this practice.

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