SAN FRANCISCO — The erstwhile antimalarial drug hydroxychloroquine is gaining new respect, as study results point to its ability to prevent long-term lupus-induced renal damage in patients living longer lives.
The multicenter, multiethnic cohort included 582 patients with systemic lupus erythematatosus (SLE) who were followed for a mean of 5.5 years, according to data presented during the annual meeting of the American College of Rheumatology.
Treatment with hydroxychloroquine, long used as a disease-modifying antirheumatic drug (DMARD), was far less common among the 73 patients who had developed new-onset renal damage (defined as glomerular filtration rate of less than 50%, 24-hour protein of at least 3.5 g, and end-stage renal disease) than among those who did not, reported Dr. Graciela S. Alarcón of the University of Alabama at Birmingham.
Because hydroxychloroquine is often prescribed only to patients with mild, early-stage disease, statistical modeling was used to ensure that demographic and disease severity differences were accounted for between the two patient groups, she explained.
“After making adjustment for all of the [potentially confounding] variables, the protection is on the order of 70%,” said Dr. Alarcón.
“Our data strongly suggest that if renal damage is to be prevented, hydroxychloroquine should be prescribed to all lupus patients early in the course of the disease,” concluded the report from Dr. Alarcón and associates at the University of Puerto Rico, San Juan, and the University of Texas, Houston.
Hydroxychloroquine, marketed as Plaquenil, has long been known as a relatively safe, inexpensive, disease-modifying drug for rheumatic diseases, having originally proven its muster against malaria during World War II.
In recent years, however, it has taken a back seat to more powerful disease-modifying medications, especially methotrexate and the biologics.
In treatment algorithms, hydroxychloroquine hovers in the “mild disease” column, generally used only for early-stage patients with nonerosive RA.
Over half of lupus patients develop renal involvement, with 10%–30% eventually experiencing renal damage and, often, end-stage renal disease, she said.
A safe, inexpensive drug that could prevent a “very serious complication” in a substantial majority of patients would represent a highly significant improvement in their long-term care, she said.
Dr. Alarcón reported no financial conflicts of interest.
Use of hydroxy-chloroquine by lupus patients reduced their risk for early renal damage by about 70%. DR. ALARCÓN