Hydroxychloroquine: From Malaria to Autoimmunity

Abstract

Quinine was first recognized as a potent antimalarial agent hundreds of years ago. Since then, the beneficial effects of quinine and its more advanced synthetic forms, chloroquine and hydroxychloroquine, have been increasingly recognized in a myriad of other diseases in addition to malaria. In recent years, antimalarials were shown to have various immunomodulatory effects, and currently have an established role in the management of rheumatic diseases, such as systemic lupus erythematosus and rheumatoid arthritis, skin diseases, and in the treatment of chronic Q fever. Lately, additional metabolic, cardiovascular, antithrombotic, and antineoplastic effects of antimalarials were shown. In this review, we discuss the known various immunomodulatory mechanisms of antimalarials and the current evidence for their beneficial effects in various diseases and in potential novel applications.

Associations of Hydroxychloroquine Use With Lipid Profiles in Rheumatoid Arthritis: Pharmacologic Implications

“…At the cellular level and in nonhuman studies, chloroquine has been reported to impede cholesterol synthesis by inhibiting lysosomal hydrolysis of cholesterol esters, and by increasing the pH within, this leads to inactivation of acid proteases (39). Data indicate HCQ also increases LDL receptors and activity of HMG-Co reductase and slows degradation of the enzyme (26,27,40). The consistent finding of a lack of HDL benefit in our and other cohorts may imply that HCQ lacks the mechanism whereby statins raise HDL levels and exhibits similar discordance as statins in its ability to lower LDL but not increase HDL, or has a dose-dependent relationship (as statins have) in raising HDL levels (41)(42)(43).…”

A Case of Treatment with Steroid and Hydrochloroquine of Thrombocytopenia in Primary Sjögren's Syndrome

“…Given that it was recently found that hydroxychloroquine has anticancer, antithrombotic, and antibiotic effects, the scope of hydroxychloroquine application is thus being extended. 9 In addition, since hydroxychloroquine inhibits platelet agglutination and arachidonic acid secretion, and it also suppresses the action of antiphospholipid antibodies, it is used to prevent thromboembolism in patients who are hard to move and antiphospholipid syndrome patients. 9 By administering hydroxychloroquine to the patient in the present case (who has a history of thromboembolism), it may have a dual effect insofar as it not only treats thrombocytopenia, but it also prevents thromboembolism.…”

Chikungunya

“…Most studies involved a small number of patients, and different methodologies were used; thus, it is currently impossible to draw conclusions regarding the efficacy of these drugs, or to assess the superiority of different therapies in patients with chronic Chikungunya. 60,61,62,63 The use of these drugs is based on extrapolation from their use in the treatment of chronic rheumatic diseases. 3,53,60,61,62 For CHIK CIR the DMARD modality should be come at first as the destruction can be prevented early.…”

“…60,61,62,63 The use of these drugs is based on extrapolation from their use in the treatment of chronic rheumatic diseases. 3,53,60,61,62 For CHIK CIR the DMARD modality should be come at first as the destruction can be prevented early. For RA and SA, The treatment modalities are well defined for both diseases, methotrexate has a special position.…”

“…6MDHAQ = Multi-Dimensional Health Assessment Questionnaire. 7RAPID 3 is significantly correlated with disease activity score (such as DAS28) 3 control of arthritis and musculoskeletal pain 53,62 and its potential antiviral action, but most of all, it is a safer drug than methotrexate in the context of being prescribed by nonspecialists. 64,65 .…”