The efficacy of antimalarials in systemic lupus erythematosus

The use of antimalarial drugs to treat systemic lupus erythematosus (SLE) is reviewed regarding their value in SLE of mild-to-moderate disease activity, as corticosteroid-sparing agents, and as an adjunctive therapy in severe SLE. A retrospective controlled study of a variety of antimalarials and a randomized discontinuation trial of hydroxychloroquine support the considerable clinical belief that antimalarials are of benefit in mild-to-moderate SLE. Anecdotal reports and the opinion of experienced clinicians suggest that antimalarials permit the use of lower doses of corticosteroids. No controlled study has confirmed a corticosteroid-sparing role for antimalarials, although no controlled study has been conducted specifically to address this hypothesis. The data on antimalarials in severe SLE are scant. Antimalarials are likely effective in at least a subgroup of SLE patients with mild-to-moderate disease activity. Whether these agents are corticosteroid sparing and prevent severe disease exacerbations is unproven. Given the low toxicity of antimalarials, further studies are clearly warranted.