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.
Short-Term Use of Hydroxychloroquine Reduces Cholesterol in Lupus
Hydroxychloroquine reduces low-density lipoprotein cholesterol levels in systemic lupus erythematosus: a longitudinal evaluation of the lipid-lowering effect
Cairoli E, Rebella M, Danese N, Garra V, and Borba E. Lupus. 2012 May 28. doi: 10.1177/0961203312450084. [Epub ahead of print]
What is the topic?
Lupus patients are at significantly increased risk for cardiovascular disease. This increased risk relates to both traditional and non-traditional risk factors and is especially increased in those patients taking steroids.
What did the researchers hope to learn?
The researchers hoped to learn the short-term effects of anti-malarial drugs on cholesterol levels in people with lupus.
Who was studied?
Twenty-four people with lupus were recruited into the study from the Systemic Autoimmune Diseases Unit of the Universidad de la República, Uruguay.
How was the study conducted?
Exclusion criteria were as follows: current use of cholesterol-lowering drugs, diabetes mellitus, and/or the presence of thyroid, liver, or kidney disease.
Disease activity was measured with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Clinical and laboratory data were recorded periodically for each patient over a three-month period while taking hydroxychloroquine (200 mg/day). Fasting cholesterol levels were measured at study entry and after the three-month period.
What did the researchers find?
Upon entry to the study, the lupus patients were, on average, 37 years old and had lupus for an average of 6.5 years. Most patients were white women and they, for the most part, had moderate lupus disease activity. All patients were positive for anti-nuclear antibodies and about 80% of them had anti-double-stranded DNA antibodies. About half of the patients were taking steroids and almost a quarter were taking azathioprine.
After the three-month treatment with hydroxycholoroquine, lupus patients showed significant reductions in both total cholesterol and low-density lipoprotein cholesterol (the so-called “bad cholesterol”), but no significant reduction in triglycerides (fat in the blood). In parallel, these patients were also able to significantly reduce their steroid intake (by about half). This reduction, however, was not associated with decreases in either total cholesterol or bad cholesterol.
What were the limitations of the study?
This study included a small number of lupus patients with only moderate disease activity.
What do the results mean for you?
Short-term (three months) use of hydroxychloroquine, an anti-malarial drug, is sufficient to reduce total cholesterol and bad cholesterol in the blood of lupus patients. Thus, its use in people with lupus may help in reducing their increased risk of cardiovascular disease. However, these findings need to be replicated in a larger group of patients with more severe disease activity. Lupus patients should work with their physicians to monitor their cardiovascular risk over time.
The findings highlight specific kinds of changes in lupus biomarkers that are most associated with effective use of belimumab in the treatment of lupus.