By Roberta Friedman, PhD
SAN FRANCISCO, Calif -- October 28, 2008 -- Hydroxychloroquine,the drug that has treated malaria for decades, may prevent the kidney damage that can occur in patients with systemic lupus erythematosus (SLE), according to research presented at the American College of Rheumatology (ACR) - Association of Rheumatology Health Professionals (ARHP) Annual Scientific Meeting.
Graciela S. Alarcón, MD, Professor of Clinical Immunology and Rheumatology, University of Alabama, Birmingham, Alabama, presented the study findings at a press conference on October 27.
Hydroxychloroquine had previously been shown to be associated with fewer flares, less tissue damage, and better overall survival in patients with lupus. Dr. Alarcón and colleagues conducted their study to determine whether use of this drug had any effect on the development of renal damage, one of the most serious complications of SLE.
Dr. Alarcón presented data from an analysis of findings on a multienthnic cohort of 582 patients aged 16 years or more who had had lupus for up to 5 years at baseline. Of these, 506 were taking hydroxychloroquine and 76 were not.
The researchers defined kidney damage as a glomerular filtration rate of <50%, a 24-hour protein level of =>3.5 g, and the presence of end-stage renal disease. They compared variables from socioeconomic-demographic, clinical, immunological, and genetic domains between hydroxychloroquine takers and nontakers to adjust for confounding variables. Variables with a P value of <=0.10 were included into a multivariable Cox proportional hazards regression model.
Results of the analysis show that 73 patients developed kidney damage. Those taking hydrochloroquine were found to be less likely to have developed kidney disease (hazard ratio [HR] of 5.75, P < .0001), to have less severe manifestations of lupus (weighted Systemic Lupus Activity Measure-Revised, HR = 1.10, P < 0.0001), and to require lower doses of corticosteroids than their nontaking counterparts.
After further adjusting for variables associated with taking hydroxychloroquine (as, according to the investigators, those taking the drug usually have milder disease and use lower doses of glucocorticoids), the therapy was still found to protect against kidney disease (P < .0001).
"Hydroxychloroquine protects on the order of 70%" against renal damage in patients with lupus, said, Dr. Alarcón. "We [now] have 3 studies that come to the same conclusion," which helps solidify evidence, she said, from these retrospective analyses.
"The implication is [that] this medicine should be used in all patients with lupus," commented Andreas Reiff, MD, University of Southern California and Children's Hospital, Los Angeles, California, who moderated the press conference.
"In addition to the bigger guns," he said, "you need hydroxychloroquine."
[Presentation title: Protective Effect of Hydroxychloroquine (HCQ) on Renal Damage in Patients With Systemic Lupus Erythematosus (SLE): Data from a Multiethnic Cohort. Abstract 2061]
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