Extended reports
Long term effectiveness of antimalarial drugs in rheumatic
diseases
a Division of Rheumatology, Department of Medicine,
University of Alberta, Canada, b Health Care Quality Outcome and Research Centre,
Faculty of Medicine, University of Alberta, Canada, c Department of Public Health Sciences,
University of Alberta, Canada
Correspondence to: Dr A Aviña-Zubieta, Clinical Epidemiology Research Unit, Hospital de Especialidades 7° Piso, Centro Medico La Raza, Instituto Mexicano del Seguro Social, Seris y Zaachila SN, Mexico, DF 02990, Mexico.
Accepted for publication 26 June
1998
OBJECTIVE
The purpose of this study was to compare
the long term effectiveness between chloroquine (CQ) and
hydroxychloroquine (HCQ).
METHODSMedical 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 inefficacy, or both. Bivariate analysis including t tests and 
2 tests were
used to assess differences 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.
RESULTSAfter 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 effects 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 differences, sex, disease type,
disease duration before treatment, and rank selection, there were no
differences 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 inefficacy was significantly higher for HCQ
(HR= 1.4, 95% CI 1.1, 1.9).
CONCLUSIONSAfter adjusting for time and several
confounders HCQ was less toxic but less effective 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.
© 1998 by Annals of the Rheumatic Diseases
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