Hydroxychloroquine in lupus: emerging evidence supporting multiple beneficial effects

Abstract

Due to multiple beneficial effects, including control of disease activity, reduction in cardiovascular events and improved survival, hydroxychloroquine is now recommended long‐term for all patients with systemic lupus erythematosus. However, patients must be made aware of the possible risk of retinal toxicity and have eye examinations to monitor for this complication. As hydroxychloroquine becomes more widely used in systemic lupus erythematosus, physicians must also be aware of rare but serious adverse effects, including neuromyotoxicity and cardiotoxicity.

Why are kids with lupus at an increased risk of cardiovascular disease?

“…In vitro plasmacytoid dendritic cells from SLE patients treated with hydroxychloroquine showed an impaired ability to produce interferon-α (IFN-α) and tumor necrosis factor-α when stimulated with TLR-9 and TLR-7 agonists [152]. In addition to its efficacy in preventing flares of SLE, there is epidemiological evidence [74,98,153] that it may be cardioprotective, possibly by improving the lipoprotein profile [154] and improving vessel elasticity [155]. A recent longitudinal study [156] of 24 patients with SLE treated with hydroxychloroquine showed a reduction in total cholesterol and LDL after 3 months of therapy.…”

Therapy and pharmacological properties of hydroxychloroquine and chloroquine in treatment of systemic lupus erythematosus, rheumatoid arthritis and related diseases

“…Their efficacy in discoid and systemic lupus has been well established (Littler 1990;Rynes 1992Rynes , 1997Dubois 1967;Laaksonen et al 1974;Maksymowych and Russell, 1987;Tett et al 1990;Fox et al 1996;Canadian Rheumatology Association 2000;Das et al 2002Das et al , 2007Dawson et al 2005;Khamashta 2008, 2010;Ruiz-Irastorza et al 2010;Tang et al 2012). A systematic review of randomised controlled trials and observational studies on the clinical efficacy and safety of anti-malarials (AMs) by Ruiz-Irastorza et al (2010) showed that (a) high levels of evidence exist for AMs (mainly HCQ) in preventing lupus flares, increased long-term survival of patients and lupus activity in pregnant women without harm to babies; (b) moderate evidence exists for their prevention of irreversible organ damage, prevention of bone destruction, and prevention of thrombosis; and (c) weaker evidence exists for reduction in severe lupus activity, lipid levels and sub-clinical atherosclerosis.…”

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

“…Hydroxychloroquine (HCQ) is often used in combination with other traditional disease-modifying antirheumatic drug (DMARD) treatment regimens and is reported to lower atherogenic lipids in systemic lupus erythematosus as well as in RA (17)(18)(19). However, HCQ is often discontinued once biologic agents are commenced in RA treatment regimens (20).…”