REVIEW - Clinical efficacy and side effects of antimalarials in SLE

[Guest guest]

Ann Rheum Dis. Published Online First: 22 December 2008.

doi:10.1136/ard.2008.101766

--------------------------------------------------------------------------------

Extended Report

Clinical efficacy and side effects of antimalarials in systemic lupus

erythematosus: a systematic review

Guillermo Ruiz-Irastorza 1*, Ramos-Casals 2, Pilar Brito-Zeron

2 and Munther A Khamashta 3

1 Hospital de Cruces, Spain

2 Hospital Clinic, Spain

3 Lupus Research Unit, United Kingdom

Abstract

Background: Antimalarial drugs (AM), chloroquine (CQ) and

hydroxychloroquine (HCQ), are frequently withdrawn in lupus patients

with either severe or remitting disease. However, additional effects

beyond immunomodulation have been recently described. Our aim was to

analyse all the published evidence of the beneficial and adverse

effects of AM therapy in SLE.

Methods: Systematic review of the English literature between 1982-2007

using MEDLINE and EMBASE. Randomised controlled trials (RCTs) and

observational studies were selected. Case reports were excluded except

for toxicity reports. The GRADE system was used to analyse the quality

of the evidence.

Results: 95 articles were included in the systematic review. We have

found high evidence that AM prevent lupus flares and increase

long-term survival of SLE patients; moderate evidence of protection

against irreversible organ damage, thrombosis and bone mass loss

..Toxicity related to AM is infrequent, mild and usually reversible,

with HCQ having a safer profile. In pregnant women, we have found high

evidence that AM, particularly HCQ, decrease lupus activity without

harming the baby. On the other hand, evidence supporting an effect on

severe lupus activity, lipid levels and subclinical atherosclerosis

was weak. Individual papers suggest effects in preventing the

evolution from SLE-like to full-blown SLE, influencing vitamin D

levels and protecting lupus patients against cancer.

Conclusion: Given the broad spectrum of beneficial effects and the

safety profile, HCQ should be given to most patients with SLE during

the whole course of the disease, irrespective of its severity, and be

continued during pregnancy.

http://ard.bmj.com/cgi/content/abstract/ard.2008.101766v1?papetoc

Not an MD