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This study assessed the efficacy and side effects of HCQ in children with proliferative lupus nephritis (LN). This double-blind, randomized, placebo-controlled trial study was conducted on 60 children with proliferative LN classes III and IV treated with steroids and a mycophenolate (MMF) regimen. Patients were categorized into two groups, the HCQ group (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200930) and the placebo group (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200930). They were evaluated initially at 6- and a 12-month follow-up by mucocutaneous, ophthalmological examination, and investigations (BUN, creatinine, 24\u00a0h proteinuria, triglycerides (TG), cholesterol, Antids-DNA, C3, C4). Disease activity was assessed using the SLE disease activity index (SLEDAI-2\u00a0k). After 12\u00a0months, TG, cholesterol, 24\u00a0h proteinuria, Antids-DNA, and SLEDAI score were significantly decreased in the HCQ group (\n                    <jats:italic>P<\/jats:italic>\n                    : 0.002, 0.012, 0.031, 0.001, respectively). After 12\u00a0months, the cumulative probabilities of developing primary end-points (LN partial and complete remission) were 40% and 60% in the HCQ group versus 53.3% and 36.7% in the placebo group (\n                    <jats:italic>P<\/jats:italic>\n                    : 0.002). After 12\u00a0months, the HCQ group experienced mucocutaneous alopecia (3.3%), hyperpigmentation (10%), and ophthalmological mild retinal changes (6.7%), but they did not differ significantly from the placebo group.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>\u00a0 Cunclusion<\/jats:italic>\n                    : HCQ improved the disease and LN activity in children with proliferative LN, with documented skin hyperpigmentation and mild retinal changes following HCQ use in a few cases. This study was registered on\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\/\">http:\/\/www.clinicaltrials.gov\/<\/jats:ext-link>\n                    with trial registration number (TRN): NCT03687905, September 2018 \u201cretrospectively registered.\u201d\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              \u2022\n                              <jats:italic>Hydroxychloroquine (HCQ) is documented as an adjunctive treatment in children with systemic lupus erythematosus (c-SLE) LN with efficacy in improving lupus musculoskeletal and mucocutaneous manifestations<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              \u2022\n                              <jats:italic>Due to the paucity of studies, its effects and side effects in children with LN remain unclear<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is New:<\/jats:bold>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              \u2022\n                              <jats:italic>This pilot randomized clinical trial assessed the efficacy and adverse effects of HCQ in children with proliferative LN<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              \u2022\n                              <jats:italic>HCQ had numerous advantages for LN, including rapid and sustained remission, antilipidemic effect, and rapid improvement of kidney functions<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-023-04837-0","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T18:16:41Z","timestamp":1675880201000},"page":"1685-1695","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Hydroxychloroquine in children with proliferative lupus nephritis: a randomized clinical trial"],"prefix":"10.1007","volume":"182","author":[{"given":"Fatma Sayed","family":"Gheet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba El-Sayed","family":"Dawoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed Ahmed","family":"El-Shahaby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shymaa Mohamed","family":"Elrifaey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7940-9906","authenticated-orcid":false,"given":"Hend Hassan","family":"Abdelnabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,2,8]]},"reference":[{"issue":"59","key":"4837_CR1","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1093\/rheumatology\/keaa381","volume":"5","author":"M Gasparotto","year":"2020","unstructured":"Gasparotto M, Gatto M, Binda V, Doria A, Moroni G (2020) Lupus nephritis: clinical presentations and outcomes in the 21st century. 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