Early use of hydroxychloroquine may protect against organ damage in lupus

Lupus Foundation of America

Resource Content

People with lupus who were treated with hydroxychloroquine (HCQ), an anti-malarial drug, early after a diagnosis of lupus had less cumulative organ damage at three years after diagnosis than those who did not receive HCQ, according to a new analysis conducted by investigators at the University of Toronto and published in a recent online issue of the Journal of Rheumatology. The investigators found that the use of hydroxychloroquine early after a diagnosis of lupus is associated with less damage (as measured by an instrument that measures damage due to lupus or its treatments) and that this difference can be picked up as early as three years after diagnosis (earlier than in previous reports).

A number of papers in recent years have provided growing evidence of the beneficial effects of anti-malarial drugs, such as HCQ, to treat symptoms of lupus and prevent disease flares. However, existing studies have not focused on examining the effects of early HCQ use on organ damage. Since current evidence indicates that organ damage occurs within the first few years after the onset of lupus, it is important to identify protective factors to preserve survival, functioning, and quality of life for people with lupus.

The Toronto group first updated an earlier review of relevant medical literature to describe the existing evidence for the beneficial effects of hydroxychloroquine in lupus. They analyzed data from 47 previously published journal articles on clinical trials and observational studies involving anti-malarial drugs. While the literature review found evidence of benefits of HCQ over time, the investigators still wanted to know whether some benefits could be seen as early as three years.

The investigators conducted their own study and analyzed data from people with lupus seen at the University of Toronto Lupus Clinic and who were diagnosed with lupus within one year of enrollment between 1970 and 2009. The investigators identified, from the database, several hundred patients with a diagnosis of lupus made less than one year prior to entry into the registry.

Subsequently, the investigators narrowed their study to 151 individuals who, at three years after diagnosis, had already experienced organ damage, and then matched those individuals to an equal number of patients who after three years had no measurable organ damage. The pairs were matched by calendar year of diagnosis and disease severity. The investigators then conducted an in-depth analysis to examine multiple variables and their possible relationship to organ damage.

Their analysis found that those individuals who received HCQ with or without immunosuppressive drugs, (such as azathioprine, methotrexate, cyclophosphamide, mycophenolate mofetil, cyclosporine) or steroids, had accumulated less organ damage at year three while those who did not received HCQ were at higher risk. The investigators also found that age, as well as greater lupus activity and higher dose of steroids (considered together as one variable) were also associated with increased damage in those patients. The data suggests that the early use of HCQ had a protective effect against organ damage in people with lupus.

The investigators acknowledge there are some limitations to their analysis. However, they feel their findings provide further evidence and support for the early use of HCQ in lupus patients.

The early protective effect of hydroxychloroquine on the risk of cumulative damage in patients with systemic lupus erythematosus.
Akhavan PS, Su J, Lou W, Gladman DD, Urowitz MB, and Fortin PR. (2013). 
Journal of Rheumatology 2013 Apr 15.