Antimalarial drug toxicities in patients with cutaneous lupus and dermatomyositis: A retrospective cohort study

Mittal, Lavanya; Zhang, Lingqiao; Feng, Rui; Werth, Victoria P.

doi:10.1016/j.jaad.2017.09.061

Cited by 42 publications

(33 citation statements)

References 23 publications

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“…However, QC is not available in most European countries because of reports of aplastic anemia. Of note, in the study of Mittal et al, no severe anemia or retinopathy was observed with QC [62].…”

Section: Switch Of Am Agent or Addition Of Qcmentioning

confidence: 78%

Current Concepts and Future Approaches in the Treatment of Cutaneous Lupus Erythematosus: A Comprehensive Review

Chasset

Françès

2019

Drugs

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Standard treatment of cutaneous lupus erythematosus (CLE) includes preventive measures such as smoking cessation and photoprotection associated with topical therapies and antimalarial agents, which are recommended as first-line systemic treatment. In more severe disease, alternative therapeutic options include immunosuppressive and immunomodulatory drugs. Recently, the development of specific tools to assess CLE activity and the publication of European CLE guidelines have improved the management of CLE. Moreover, several biologic agents are currently studied specifically in CLE or in systemic lupus erythematosus with assessment of skin involvement and may be promising therapies. However, improvement of the management of CLE remains a major unmet need. In this review, we summarize current concepts in the management of CLE as well as future approaches for more targeted treatments. Key points:  Some targeted agents that have shown some promise in skin manifestations with systemic lupus erythematosus.  Future studies are needed specifically for cutaneous lupus erythematosus (CLE), with responses for each of the CLE subtypes reported separately.

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Section: Switch Of Am Agent or Addition Of Qcmentioning

confidence: 78%

Current Concepts and Future Approaches in the Treatment of Cutaneous Lupus Erythematosus: A Comprehensive Review

Chasset

Françès

2019

Drugs

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“…glucocorticoids may not be practical, oral antimalarials are also considered first‐line therapy. HCQ is most often the first used in the US, as it is effective with a more favorable side effect profile than chloroquine (16). If the disease does not respond to HCQ, quinacrine can be added.…”

Section: Clinical Challengementioning

confidence: 99%

Expert Perspective: An Evidence‐Based Approach to Refractory Cutaneous Lupus Erythematosus

Borucki

Werth

2020

Arthritis & Rheumatology

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Cutaneous lupus erythematosus (CLE) is a chronic autoimmune disease that can present with a variety of skin manifestations and have a dramatic effect on a patient’s quality of life. Effective treatment options for this disease are limited, and the efficacy of these treatments is often supported by low levels of evidence. This makes the treatment of refractory disease especially challenging, as it is difficult to achieve a consensus on the appropriate progression of treatment beyond first‐ and second‐line treatment options. The treatment of refractory CLE often involves some degree of immunosuppression, which carries some risk for patients and requires a thoughtful approach to the selection of medications. Some treatments that have proven to be effective in systemic disease may not be as effective in cutaneous disease, making it difficult to extrapolate from the available evidence on systemic lupus erythematosus (SLE). Ultimately, the increased use of objective skin measurements in SLE clinical trials is necessary to understand drug efficacy in CLE and develop new treatments for this challenging disease. Here, we provide clinical examples of the challenges involved in treating refractory CLE, examine the evidence currently available for treatment options, and provide an algorithmic approach to the treatment of refractory disease based on this evidence. Novel therapies under development for CLE are also discussed, as they may soon be part of the accepted treatment regimen for refractory CLE.

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“…Mittal et al recently reported a 11% rate of antimalarialinduced cutaneous hypersensitivity eruptions in a combined dermatology clinic-ascertained cohort of 532 cutaneous LE and dermatomyositis patients (30% of this patient cohort had dermatomyositis) (28). In addition, Chasset et al concurrently reported a 3-12% rate of antimalarialsinduced cutaneous hypersensitivity reactions in their study group of 64 French antimalarial-treated cutaneous LE patients (29).…”

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confidence: 99%

Aminoquinoline antimalarial therapy in dermatomyositis—are we missing opportunities with respect to comorbidities and modulation of extracutaneous disease activity?

Sontheimer

2018

Ann. Transl. Med.

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It is now widely accepted that long-term aminoquinoline antimalarial therapy with hydroxychloroquine (HCQ) can mitigate one of the most important comorbidities of systemic lupus erythematosus (LE)-atherosclerotic cardiovascular disease (ASCVD). Increasing evidence suggests that idiopathic inflammatory myopathy (IIM) patients have a risk for ASCVD comorbidity that is similar to that of systemic LE. I would like to explore the primary hypothesis that long-term HCQ therapy could provide those with IIM, especially dermatomyositis (DM) patients, an ASCVD comorbidity benefit similar to that of systemic LE. In addition, while HCQ is known to have clinical benefits for the cutaneous manifestations of DM, I would also like to explore the secondary hypothesis that HCQ might have steroid-sparing effects on one or more of the systemic manifestations of DM.

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Antimalarial drug toxicities in patients with cutaneous lupus and dermatomyositis: A retrospective cohort study

Abstract: With the exception of retinopathy, which was not seen with Q, the risks for other toxicities associated with Q monotherapy or combination treatment were not significantly different from those with HCQ.

Cited by 42 publications

References 23 publications

Current Concepts and Future Approaches in the Treatment of Cutaneous Lupus Erythematosus: A Comprehensive Review

Current Concepts and Future Approaches in the Treatment of Cutaneous Lupus Erythematosus: A Comprehensive Review

Expert Perspective: An Evidence‐Based Approach to Refractory Cutaneous Lupus Erythematosus

Aminoquinoline antimalarial therapy in dermatomyositis—are we missing opportunities with respect to comorbidities and modulation of extracutaneous disease activity?

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