Antimalarial drug toxicities in patients with cutaneous lupus and dermatomyositis: a retrospective cohort study

Publication date: Available online 6 October 2017
Source:Journal of the American Academy of Dermatology
Author(s): Lavanya Mittal, Lingqiao Zhang, Rui Feng, Victoria P. Werth
BackgroundAlthough existing evidence demonstrates the efficacy of antimalarials for rheumatic skin disease, the safety of these medications, and particularly quinacrine, remain debated.ObjectiveWe investigate the toxicity risk associated with antimalarials in patients with cutaneous lupus erythematosus (CLE) and dermatomyositis (DM).Methods532 patients (Mean age=52.29 years, Female=85.15%, Male=14.85%) were selected from two databases of CLE (69.92%) and DM (30.08%). Details regarding treatment and toxicities were extracted and five treatment courses were defined [i.e., hydroxychloroquine (HCQ), chloroquine (CQ), quinacrine (Q), hydroxychloroquine-quinacrine (HCQ-Q), and chloroquine-quinacrine (CQ-Q)]. The hazard ratio for each major toxicity was estimated using the Cox proportional hazard model to compare the different treatments to HCQ.ResultsThe most common toxicities included cutaneous eruption, gastrointestinal (GI) upset, mucocutaneous dyspigmentation, neurologic, and retinopathy. Compared to HCQ, the hazards of cutaneous eruption, GI upset, and neurologic toxicities were lower with HCQ-Q; however, this may represent selection bias. Although there was increased retinopathy risk with CQ and CQ-Q relative to HCQ, retinopathy was not seen with Q.LimitationsRetrospective analysisConclusionsWith the exception of retinopathy, which was not seen with quinacrine, the risks of other toxicities associated with quinacrine monotherapy or combinational treatment were not significantly different than with hydroxychloroquine.

Teaser

Antimalarials are effective for rheumatic skin diseases, but have been associated with retinopathy.We investigated the toxicity risk of antimalarials alone and in combination.Antimalarials were generally well tolerated and had similar risk profiles. Risk of retinopathy seems to be lowest for quinacrine, then hydroxychloroquine, and highest for chloroquine.