Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: A systematic review
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
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