Efficacy of antimalarials in systemic lupus erythematosus

No recent study has been published on the efficacy of antimalarial drugs in the treatment of systemic lupus erythematosus (SLE). However, antimalarial drug therapy was reported in several early studies to control SLE more effectively than corticosteroids alone and to permit lower doses of steroids to be used. To confirm these findings, we conducted a retrospective study of 43 SLE patients who had been taking antimalarials but in whom such therapy had been discontinued after two to 13 years due to the development of macular changes. Each patient served as his own control by the matching of each year during which antimalarial drugs were taken with one year without antimalarial medication. There was a total of 76 matched years for the 43 patients. Overall, no significant correlation was shown between antimalarial drug therapy and the presence or absence of general symptoms (fever, fatigue, weight loss); skin, cardiac, pulmonary, or central nervous system manifestations, arthritis, or other symptoms or signs that were measured. Although antimalarials reduced the required dosage of corticosteroids significantly (p less than 0.05), the amount of reduction was not considered clinically meaningful. Treatment with antimalarial drugs significantly reduced the number of disease flare-ups (p less than 0.05). There were also significant differences between the years with and without chloroquine therapy 500 mg per day (the only regimen for which adequate data were available for analysis) in terms of general symptoms and skin manifestations (p less than 0.05). A prospective, double-blind study of large numbers of patients would be important to confirm the findings of this retrospective study--and the observations of many rheumatologists that antimalarials are helpful in the treatment of SLE.