Kombination der Antimalariamittel Mepacrin und Chloroquin bei therapieresistentem kutanem Lupus erythematodes

Abstract

Antimalarials represent the first line in treatment of cutaneous lupus erythematosus (LE). However, some patients show no improvement on monotherapy with chloroquine or hydroxychloroquine. A 30-year-old female patient had treatment-resistant cutaneous LE exhibiting features of both LE tumidus and subacute cutaneous LE. Previously, the patient had been unsuccessfully treated with chloroquine, hydroxychloroquine, dapsone, and azathioprine, each in combination with variable doses of prednisolone. However, the LE lesions increased during these therapeutic regimens. A combination of chloroquine and mepacrine therapy led to improvement and then total clearing after 4 months of treatment.

Influence of smoking on disease severity and antimalarial therapy in cutaneous lupus erythematosus: analysis of 1002 patients from the EUSCLE database

“…35 Some authors believe that HCQ is safer but less effective than CQ considering the well-known side-effects, such as irreversible retinopathy. [41][42][43] The results of the present study suggest that quinacrine is highly efficient in patients with CLE; however, only a low number of patients applying quinacrine were included in the study. 37 The results of the present analysis demonstrated a slightly higher efficacy of HCQ (86Á9%) compared with CQ (81Á5%) in all CLE subtypes.…”

“…39 Moreover, a recently published prospective longitudinal cohort study of 128 patients with CLE, 40 as well as several case reports, confirmed that a combination of HCQ or CQ with quinacrine, respectively, is highly effective. [41][42][43] The results of the present study suggest that quinacrine is highly efficient in patients with CLE; however, only a low number of patients applying quinacrine were included in the study.…”

Early Diagnosis and Treatment of Discoid Lupus Erythematosus

“…Some patients do not respond well to monotherapy with either hydroxychloroquine or chloroquine, and in such cases the addition of mepacrine may be of benefit. 15 In general, hydroxychloroquine and mepacrine are safe, well-tolerated drugs and adverse effects are relatively few, the most widely recognized being retinal toxicity. 16 Chloroquine causes macular pigmentation that progresses to a typical bull's eye lesion and then to widespread retinal pigment epithelial atrophy resembling retinitis pigmentosa.…”

Cutaneous lupus erythematosus: Update of therapeutic options

“…Several case reports have been published demonstrating that the combination therapy is highly efficient in patients with different subtypes of CLE (DLE, SCLE, and LE panniculitis). [92][93][94] Moreover, quinacrine (100 mg per day) was added in patients with SLE, who were maintained on prednisolone and hydroxychloroquine (some also on azathioprine). 95 Three months after the initiation of quinacrine treatment, disease activity measured by the SLE Disease Activity Index and anti-double-stranded DNA and anticardiolipin antibodies were reduced, followed by reduction or discontinuation of prednisolone in all patients and azathioprine in some patients.…”