Antimalarial use in SLE

For years the thinking regarding SLE was that one treats manifestations and complications but that there was no basic treatment for the disease itself. Over time that perception has changed with accumulating evidence that antimalarials might alter the natural history of the disease and maybe even improve survival. A new study posted ahead of print in Arthritis and Rheumatism indicates a protective effect of hydroxychloroquine against thrombovascular events:

Fifty-four cases were identified and matched to 108 controls. Univariate analyses identified age (OR, 95%CI = 1.04, 1.01-1.07) or being older than 50 years old (3.5, 1.4-8.6) and hypertension (2.5, 1.0-5.8) as being associated with an increased risk of TE while use of antimalarials (0.31, 0.13-0.71) was associated with a decreased risk of TE. Separate analyses were done for arterial and venous TE. In multivariate analysis, use of antimalarial drugs (0.32, 0.14-0.74) and age (1.04, 1.01-1.07) were the only two variables that remained significant for all TE.

We demonstrate in this nested case-control study adjusting for disease severity, duration of disease and calendar cohort that antimalarial drugs are thromboprotective with a risk reduction of thrombovascular event of 68% and of at least 26% and as high as 86%.

This Medscape commentary discusses other data on protective effects of hydroxychloroquine and quotes the authors:

"The data presented, taken in conjunction with the data from the published literature, suggest that antimalarials should be used in all lupus patients regardless of their disease manifestation or disease duration," the authors conclude.