Antimalarials and lupus activity
| Reference | Study type | n | AM | Race | Age (mean) | Follow-up | Main outcomes | AM effect |
| Canadian Group, 19918 | RCT | 25 HCQ | HCQ | NA | 45 | 24 weeks | SLE flare (ACR manifestations) | Lower rate of SLE flare: (36% vs 73%, p = 0.02) |
| 22 PL | Severe flare | Lower rate of severe flare: (4% vs 23%, p = 0.06) | ||||||
| Prednisone dose | No difference in dose of prednisone | |||||||
| Meinao et al, 19969 | RCT | 11 CQ | CQ | W (61%) | 32 | 12 months | SLE flare (SLEDAI) | Lower rate of SLE flare: (18% vs 83%, p<0.01) |
| 12 Pl | Prednisone dose | Higher rate of prednisone reduction: (82% vs 25%. p<0.01) | ||||||
| Williams et al, 199410 | RCT | 40 HCQ | HCQ | W (44%) | 42 | 48 weeks | Painful/swollen joints | Lower self-assessed severity of joint pain (p = 0.02) |
| 31 PL | B (42%) | Grip strength | ||||||
| Self-assessed score of severity of joint pain | ||||||||
| Tsakonas et al, 199818 | Retrospective data of extended RCT | 25 HCQ | HCQ | NA | 45 | 42 months | Time to develop a major flare | Lower rate of major flare: (28% vs 50%, p = 0.08) |
| 22 PL | ||||||||
| Wozniacka et al, 200612 | Prospective cohort | 25 | CQ | NA | 40.6 | 3 months | Change in SLAM score | Higher reduction in SLAM score: (9.47 vs 4.92, p<0.001) |
| Costedoat et al, 200613 | Prospective cohort | 120 | HCQ | NA | 36 | 6 months | SLE flare (SLEDAI) | Lower HCQ blood levels in patients with flare: (703 vs 1128, p = 0.006) |
| Serum levels of HCQ | ||||||||
| Kasitanon et al, 200617 | Retrospective cohort | 11 HCQ | HCQ | B (55%) | 29.9 | 12 months | Remission in membranous lupus nephritis treated with MMF | Higher rate of membranous lupus nephritis remission: (64% vs 22%, p = 0.036) |
| 18 no HCQ | ||||||||
| Barber et al, 200616 | Retrospective cohort | 35 | HCQ | W (85.7%) | 32.2 | 38 months | Sustained remission of lupus nephritis (⩾3 years) | More patients on sustained remission on HCQ: (94% vs 53%, p = 0.01) |
| Levy et al, 200111 | RCT | 10 HCQ | HCQ | W (45%) | 29 | Pregnancy duration | SLE activity (SLEPDAI) during pregnancy | Improvement in SLEPDAI score only in patients on HCQ (p = 0.038) |
| 10 PL | Prednisone dose | Lower prednisone dose at delivery: (4.5 vs 13.7 mg/day, p<0.05) | ||||||
| Clowse et al, 200614 | Prospective cohort | 56 HCQ | HCQ | W (61%) | NA | Pregnancy duration | SLE activity (PEA, SLEDAI) during pregnancy | Women stopping HCQ higher lupus activity than those never treated and those taking HCQ: |
| 38 HCQ previous to pregnancy | Prednisone use during pregnancy | Flare rate: 55% vs 36%, vs 30%, p = 0.053 | ||||||
| 163 no HCQ | Maximum SLEDAI: 6.5 vs 5.2 vs 4.2, p = 0.062 | |||||||
| SLEDAI >4: 84% vs 52%, vs 62%, p = 0.008 | ||||||||
| Maximum prednisone dose: 21 vs 23 vs 16, p = 0.056 | ||||||||
| Cortes-Hernandez et al, 200215 | Prospective cohort | 60 | CQ | NA | 28 | Pregnancy duration | SLE flares (SLEDAI) during pregnancy | CQ discontinuation increased flares (p = 0.02) |
ACR, American College of Rheumatology; AM, antimalarial; B, black; CQ, chloroquine; HCQ, hydroxychloroquine; MMF, mycophenolate mofetil; NA, not available; PEA, Physician's Estimate of Activity; PL, placebo; RCT, randomised controlled trial; SLAM, Systemic Lupus Activity Measure; SLE, systemic lupus erythematosus; SLE(P)DAI, SLE (Pregnancy) Disease Activity Index; W, white.