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Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: A systematic review
Annals of Rheumatic Diseases, 06/15/09

Ruiz-Irastorza G et al. – Review concludes that hydroxychloroquine (HCQ) should be given to most patients with systemic lupus erythematosus (SLE) during the whole course of the disease, irrespective of its severity, and be continued during pregnancy.

Methods

An analysis of all the published evidence of the beneficial and adverse effects of antimalarial drugs (AM) therapy in SLE
Systematic review: between 1982-2007 using MEDLINE and EMBASE
Randomised controlled trials (RCTs) and observational studies were selected
Case reports were excluded except for toxicity reports
GRADE system was used to analyse the quality of the evidence

Results

95 articles were included in the systematic review
High evidence that AM prevent lupus flares and increase long-term survival of SLE pts
Moderate evidence of protection against irreversible organ damage, thrombosis and bone mass loss
Toxicity related to AM was infrequent, mild and usually reversible, with HCQ having a safer profile
In pregnant women, high evidence that AM, particularly HCQ, decrease lupus activity w/o harming the baby
Evidence supporting an effect on severe lupus activity, lipid levels and subclinical atherosclerosis was weak
Individual papers suggest effects in preventing the evolution from SLE-like to full-blown SLE, influencing vit D levels and protecting lupus pts against cancer

Exclusive Author Commentary
GUILLERMO RUIZ-IRASTORZA, 06/09/09

This systematic review analysed the available evidence on the use of antimalarials in SLE. Data confirmed them as very effective and safe drugs for the treatment of lupus, with important long-term effects, including a decrease in mortality. More recenta data, published after this review, reinforce the role of antimalarials in preventing thrombosis, also in patients with antiphospholipid antibodies, and in preventing infections. Given the efficacy and safety profile, patients with SLE should be treated long term with hydroxiychloroquine.

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