Discontinuation of antimalarial drugs in systemic lupus erythematosus
Wang, C.; Fortin, P.R.; Li, Y.; Panaritis, T.; Gans, M.; Esdaile, J.M.
Journal of Rheumatology 26(4): 808-815
1999
ISSN/ISBN: 0315-162X PMID: 10229401 Document Number: 502954
A lupus database was reviewed to identify antimalarial use from inception to April 1996. Reasons for drug discontinuation were assessed by medical record review. Of 224 patients with systemic lupus erythematosus (SLE), 156 (70%) had received antimalarials. The 156 users received 203 courses of antimalarials, of which 197 (97%) were hydroxychloroquine (HCQ). The average duration of use was 6.9 years/patient. Antimalarials were discontinued at least once in 62 patients. When only the first course was considered, 67, 50 and 38% of patients continued to receive antimalarials at 5, 10 and 15 years, respectively. Reasons for discontinuation were disease remission in 26 (42%), side effects in 18 (29%), noncompliance in 9(15%), lack of efficacy in 5 (8%) and miscellaneous causes such as pregnancy or surgery in 4 (6%). 20 subjects were withdrawn for side effects, including gastrointestinal in 11; headache and dizziness, and nonretinal eye problems in 2 each; and hearing loss and rash in one each; 2 developed HCQ myopathy (1.9 cases/1000 patient-years of HCQ therapy); and one developed HCQ retinopathy after 6 years at a dose of 6.5 mg/kg/day (0.95 cases/1000 patient-years of HCQ). Among patients who had received HCQ for at least 6 years, 1.3% developed retinopathy. It was concluded that HCQ is well tolerated in SLE although ophthalmological testing remains essential, as retinopathy does occasionally occur.