Another benefit of hydroxychloroquine?
- Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (LUMINA L)
- Annals of the Rheumatic Diseases, Volume 66, Number 9, September 2007, pp. 1168-1172
What is the topic?
The antimalarial drug hydroxychloroquine—and to a lesser degree a similar but older medication chloroquine—is used in the treatment in lupus. Hydroxychloroquine, also known by its trade name Plaquenil®, is often prescribed for mild to moderate cases of lupus, and may be effective in preventing skin flares and possibly blood clots. Doctors also give hydroxychloroquine to lupus patients who are taking steroids, which helps them use lower doses of steroids.
What did the researchers hope to learn?
A study recently reported from Spain found that antimalarial drugs not only helped control lupus disease, but patients who took either of these drugs also lived longer than other lupus patients—even when discounting other factors. However, almost all of the patients in that study were Caucasian, so researchers here in the United States wanted to see if lupus patients from other ethnic backgrounds who were treated with hydroxychloroquine also lived longer.
Who was studied?
Since the early 1990s, the LUMINA (LUpus in MInorities: NAture vs. nurture) study has been tracking a group of lupus patients in the United States of different ethnic backgrounds. At the time this study was conducted, the LUMINA study included information on 218 Hispanics, 220 African Americans, and 170 Caucasian patients; of those 608 patients, 61 had died from various causes.
How was the study conducted?
The researchers focused on the records of the 61 patients who had died, comparing those who were taking hydroxycholoroquine (17) to those who had not (44). For every one of the deceased patients, they also examined the information for 3 surviving patients who had been diagnosed with lupus for the same amount of time. The researchers looked at demographic factors (such as income, education, and age when diagnosed) and also lupus disease symptoms, medications, lab tests. Using some statistical techniques that allowed them to account for the impact of these different variables, they came up with a way to measure if hydroxychloroquine on its own, independent of other factors, provided a protective effect that kept patients living longer.
What did the researchers find?
Like the previous study in Spain, the researchers in this LUMINA study found that hydroxychloroquine had a clear effect in terms of the survival of lupus patients. Although this might have been explained by the fact that hydroxychloroquine was used more often in people with less severe disease, they accounted for that in their analysis. By applying statistics, they found that hydroxychloroquine had an independent impact on survival.
What were the limitations of the study?
Even though the researchers designed their study to account for the effect of factors other than hydroxychloroquine, there may be other features that they didn’t account for that also were influencing the outcomes. Also, the study didn’t indicate if hydroxychloroquine’s protective benefit was the same for Caucasians, African Americans, and Hispanics.
What do the results mean for you?
Hydroxychloroquine has been shown to be an effective medicine for treating lupus, and previous studies have shown that it is associated with fewer flares of disease. Monitoring for rare complications to the eyes is important, but with such monitoring, this treatment can be used safely for long periods of time for most patients.