title: Treatment of lupus skin involvement with quinacrine and hydroxychloroquine.
abstract: To evaluate the efficacy of hydroxychloroquine (HCQ) and quinacrine (Qn) association, at two different dosages, in treatment of lupus skin lesions not responding to HCQ alone. Thirty-four patients, affected by cutaneous and systemic lupus erythematosus, were retrospectively analysed. They were treated by HCQ (5 mg/Kg/qd) and Qn with two regimens: 100 mg/qd (29 cases) and 50 mg/qd (5 cases). Discoid lupus erythematosus (19 cases), acute malar rash (6 cases), chilblain lupus (4 cases) showed a significant improvement with combination therapy (P = 0.009, P = 0.019, and P = 0.04, respectively). Ten patients with subacute cutaneous lupus showed a partial response, whereas lupus profundus didn't improve. The same overall response rate was recorded comparing two Qn regimens, but subjects taking 100 mg/qd improved more rapidly than the others (P = 0.001). Ten patients developed side effects, mainly represented by skin yellowish discolouration. Depression and severe headache with nausea, which were globally recorded in two cases, led to drug withdrawal. One additional case of hepatitis was recorded in a patient with preexisting Hepatitis C virus (HCV) infection. Combination of HCQ and Qn is rapidly effective at 100 mg/qd and well tolerated in the treatment of lupus skin lesions unresponsive to HCQ alone.
authors.affiliation: Rheumatology Unit and Chair - A.O. Spedali Civili di Brescia- Università degli Studi di Brescia, Italy. ilariacava@virgilio.it
authors.forename: I
authors.initials: I
authors.lastname: Cavazzana
authors.forename: R
authors.initials: R
authors.lastname: Sala
authors.forename: C
authors.initials: C
authors.lastname: Bazzani
authors.forename: A
authors.initials: A
authors.lastname: Ceribelli
authors.forename: C
authors.initials: C
authors.lastname: Zane
authors.forename: R
authors.initials: R
authors.lastname: Cattaneo
authors.forename: A
authors.initials: A
authors.lastname: Tincani
authors.forename: P G
authors.initials: PG
authors.lastname: Calzavara-Pinton
authors.forename: F
authors.initials: F
authors.lastname: Franceschini
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D008178:Lupus Erythematosus, Cutaneous / Q000188:drug therapy / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011796:Quinacrine / Q000627:therapeutic use*; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D018501:Antirheumatic Agents; D006886:Hydroxychloroquine; D011796:Quinacrine