The cholesterol lowering effect of antimalarial drugs is enhanced in patients with lupus taking corticosteroid drugs.
OBJECTIVE
To examine the relationship between antimalarial therapy and total cholesterol in patients with systemic lupus erythematosus (SLE) with or without steroid therapy.


METHODS
Retrospective study for the University of Toronto Lupus Clinic database between 1976 and 1997. The effects of antimalarials on random total cholesterol levels were assessed in the following situations: patients not receiving steroids (part I) that either initiated or discontinued antimalarials; patients receiving steroids (part II) that were either on a stable dose or initiating antimalarials; and patients initiating steroids with or without antimalarials (part III). Paired t test, Fisher's exact test, and 2 way analysis of variance were used when appropriate.


RESULTS
Initiation of antimalarials reduced the baseline total cholesterol by 4.1 % at 3 months in 53 patients (p = 0.020) and by 0.6% at 6 months in 30 patients (p = NS), while the cessation of antimalarials increased the total cholesterol by 3.6% at 3 months in 38 patients (p = NS) and 5.4% at 6 months in 22 patients (p = NS). In 181 patients taking steroids and antimalarials, the mean total cholesterol was 11% less than for 201 patients receiving a comparable dose of steroids alone (p = 0.0023). Initiation of antimalarials on a stable dose of steroids reduced the total cholesterol by 11.3% at 3 months in 29 patients (p = 0.0002) and 9.4% at 6 months in 20 patients (p = 0.004). For patients initiating steroids, the percentage increase in cholesterol was lower in those taking antimalarials compared to patients without antimalarial therapy (p = 0.0149).


CONCLUSIONS
Antimalarials lower total cholesterol in patients receiving steroids and may minimize steroid induced hypercholesterolemia.
Rahman
P
P
University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, The Toronto Hospital, Ontario, Canada.
Gladman
D D
DD
Urowitz
M B
MB
Yuen
K
K
Hallett
D
D
Bruce
I N
IN
D000962:Antimalarials / Q000494:pharmacology* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use; D002738:Chloroquine / Q000494:pharmacology / Q000627:therapeutic use; D002784:Cholesterol / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000494:pharmacology / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000517:prevention & control; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000378:metabolism*; D011241:Prednisone / Q000494:pharmacology* / Q000627:therapeutic use; D012189:Retrospective Studies