Increased survival with hydroxychloroquine in SLE

Hydroxychloroquine has a "clear protective effect" on survival in patients with systemic lupus erythematosus (SLE), according to new findings. "In patients with SLE, hydroxychloroquine prevents disease flares and damage accrual and facilitates the response to mycophenolate mofetil in those with renal involvement," writes Dr Graciela Alarcón (University of Alabama, Birmingham) and colleagues. The group undertook the current study to assess whether hydroxychloroquine also exerts a protective effect on survival. Using data from the LUMINA study (LUpus in MInorities: NAture vs nurture) the authors performed a case-control study in which deceased patients were matched for disease duration (within six months) with alive patients (controls) in a proportion of 3:1. After a median follow up of 39 months, 61 of 608 patients had died. This included 17 deaths among 349 patients taking hydroxychloroquine initially (5 percent) and 44 in the 259 patients not taking this drug at the outset (17 percent), a significant difference favouring hydroxychloroquine. Alarcón's group comment, "This protective effect of hydroxychloroquine is probably mediated by its ability to prevent the occurrence of flares and damage, both of which can be regarded as mediators of a later outcome such as death." The authors also point out that antimalarials such as hydroxychloroquine have lipid lowering and blood sugar lowering effects as well as beneficial anti-clotting effects, all of which may independently contribute to the decreased occurrence of cardiovascular events. "Hydroxychloroquine, which overall is well tolerated by patients with SLE, has a protective effect on survival which is evident even after taking into consideration the factors associated with treatment decisions. This information is of importance to all clinicians involved in the care of patients with SLE." Reference...