Long term effectiveness of antimalarial drugs in rheumatic diseases

Abstract

Objective-The purpose of this study was to compare the long term eVectiveness between chloroquine (CQ) and hydroxychloroquine (HCQ). Methods-Medical charts of all patients seen by eight rheumatologists practising in two tertiary care centres and starting antimalarial treatment between January 1985 and December 1993 were reviewed. Patient characteristics, disease, and treatment information were collected. The main outcome measures were the cause of and the time to the discontinuation of antimalarial drugs resulting from all causes, principally toxicity or ineYcacy, or both. Bivariate analysis including t tests and 2 tests were used to assess diVerences between means and proportions respectively. Survival curves were evaluated using the Kaplan-Meier method. Multivariate analysis (Cox regression) was used to adjust for potential confounders. Results-After all medical records were reviewed, 1042 eligible cases were identified. From these, 940 (90%) had usable information and they represent the cohort. Five hundred and fifty eight had rheumatoid arthritis, 178 had systemic lupus erythematosus, 127 had palindromic arthritis, and 77 had other diagnoses. Fifty seven per cent of the patients received CQ and 43% HCQ. The proportion of patients with side eVects taking HCQ and CQ was 15% and 28% respectively (p=0.001). Using Cox regression model to adjust for age at the onset of antimalarial treatment, physician diVerences, sex, disease type, disease duration before treatment, and rank selection, there were no diVerences in the hazard ratio (HR) for overall discontinuations between CQ and HCQ. While the HR for discontinuations because of toxicity was lower for HCQ (HR= 0.6, 95% CI 0.4, 0.9), the HR for discontinuations because of ineYcacy was significantly higher for HCQ (HR= 1.4, 95% CI 1.1, 1.9). Conclusions-After adjusting for time and several confounders HCQ was less toxic but less eVective than CQ. Only one case of probable/possible retinopathy was found. Therefore, we propose a careful baseline ophthalmological evaluation by an expert and then one or every two years if proper doses are used.

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

“…Clinical applications of HCQ and CQ in treating rheumatic diseases have been widely reported (Littler 1990;Rynes 1992Rynes , 1997Dubois 1967Dubois , 1978Mackenzie 1970Mackenzie , 1983aLaaksonen et al 1974;Maksymowych and Russell 1987;Adams et al 1983;Baum 1983;Bellamy and Brooks 1986;Tett et al 1990; Kruize et al 1993;Nayak and Esdaile 1996;Fox et al 1996;Clarke 1998;Avina-Zubieta et al 1998;Conaghan et al 1997; Canadian Rheumatology Association 2000; Dawson et al 2005;Khamashta 2008, 2010;Ruiz-Irastorza et al 2010;Katz and Russell 2011). 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).…”

“…Indeed, RuizIrastorza and Khamashta (2008) have described HCQ as being the ''cornerstone of lupus therapy''. HCQ is a frequent option for the treatment of mild-moderate rheumatoid arthritis (RA) (Rynes 1992;Mackenzie 1983a, b, c;Maksymowych and Russell 1987;Bellamy and Brooks 1986;Tett et al 1990;Clarke 1998;Avina-Zubieta et al 1998;Conaghan et al 1997;Canadian Rheumatology Association 2000;Marmor 2004), Sjøgren's syndrome (Kruize et al 1993;Fox et al 1996;Clarke 1998;Dawson et al 2005) where its actions have been attributed to reversing hypoactive glandular anti-cholinesterase activity (Dawson et al 2005), and juvenile rheumatoid arthritis (Laaksonen et al 1974;Baum 1983). These drugs are amongst the cheapest of the disease-modifying anti-rheumatic agents (DMARDs) that are currently available and appreciably less costly than biologics (Choi et al 2000;RxFiles Detailing Program (2008); British National Formulary 2009).…”

Métodos diagnósticos para retinopatia induzida pelo difosfato de cloroquina nos portadores de lúpus eritematoso sistêmico

“…Apesar de apresentar maior toxicidade que a hidroxicloroquina (33) , o DFC é altamente benéfico aos pacientes lú-picos (1)(2)(3)(4)(5)(6) e apresenta baixo custo. Por seus excelentes resultados terapêuticos, o uso do DFC tende a ser cada vez mais generalizado e prolongado nestes pacientes.…”

Management of Rheumatoid Arthritis: Consensus Recommendations From the Turkish League Against Rheumatism

“…As HCQ is less toxic than CQ, it is more commonly preferred despite its lower efficacy. [48] In a systematic meta-analysis of four comparative studies, HCQ was found to be more effective than a placebo in RA. It was concluded that though it has moderate efficacy, it should be considered for use in the treatment of RA due to its low toxicity profile.…”