A randomized study of the effect of withdrawing hydroxychloroquine sulfate in systemic lupus erythematosus

Article Abstract:

Hydroxychloroquine is an antimalarial drug which, like other antimalarials such as chloroquine and quinacrine, is thought to relieve some of the symptoms of systemic lupus erythematosus. Hydroxychloroquine is thought by many to control the skin and mucous membrane lesions, the arthritis and pleuritic pain, and the malaise and easy fatigability of patients with lupus erythematosus. However, this belief is not firmly supported by experimental evidence. There is also some concern that, although such drugs are clearly safe in the treatment of malaria, the long-term consequences of their chronic use in the treatment of lupus erythematosus is less certain. To determine if the use of hydroxychloroquine is indeed justified on the basis of its benefit to the patient, a study was organized of 47 women with stable lupus who had been taking hydroxychloroquine for an average of three years. Twenty-five patients were randomly selected to continue to receive hydroxychloroquine, while 22 were randomly selected to begin receiving placebo for 24 weeks. Neither the patients nor their physicians knew which treatment they were receiving. It was observed that during the test period, 16 of 22 patients receiving placebo had flare-ups of their lupus, in contrast to 9 of 25 continuing with hydroxychloroquine. The risk of a flare-up was 2.5 times higher in the placebo group, and risk of a severe flare-up was over six times greater in the placebo group than the hydroxychloroquine group. The results indicate that patients taking hydroxychloroquine are more likely to have a flare-up if they discontinue the drug; the results also support the clinical supposition that hydroxychloroquine is useful in the treatment of lupus erythematosus. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Therapy for systemic lupus erythematosus

Article Abstract:

Lupus erythematosus is a variable clinical entity, and its treatment is largely empirical. Many treatments enthusiastically endorsed in the past have proven to be of little benefit. Severe symptoms or acute outbreaks may demand drug therapy with prednisone or even cyclophosphamide. For some time, however, there has been a suggestion that antimalarial drugs may provide some benefit for patients with mild systemic symptoms and rash despite the fact that there was little clinical data on which to base this belief. Now, however, an article published in the January 17, 1991 issue of The New England Journal of Medicine does provide some data which shed more light on this question. The researchers studied a group of women who had been taking hydroxychloroquine; these women were randomly assigned to either continue with the drug or switch to placebo. Neither the patients nor the physicians knew which patients were getting which treatment. They found that the patients who were removed from the drug experienced significantly more flare-ups of their disease than did the women who continued hydroxychloroquine treatment. While this evidence indicates that hydroxychloroquine should play a role in the treatment of mild systemic lupus, the results do not provide new indications for the use of this drug. The usefulness of the drug in serious or acute disease remains unknown, nor is it known how well other patient groups will respond which were not represented by the Canadian study. Nevertheless, the results of the study indicate that further research on the usefulness of hydroxychloroquine in the treatment of systemic lupus erythematosus should be encouraged. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus

Article Abstract:

People who have systemic lupus erythematosus may develop premature atherosclerosis, according to a study comparing 197 lupus patients to 197 healthy people. Ultrasound scans of the neck showed that 37% of lupus patients had carotid artery disease compared to 15% of the healthy group. Patients who had carotid artery disease had not received maximal treatment with immunosuppressive drugs. This indicates that atherosclerosis may have an inflammatory component.

Complications and side effects, Risk factors, Atherosclerosis

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