title: Response to antimalarial agents in cutaneous lupus erythematosus: a prospective analysis.
abstract: OBJECTIVE
  To demonstrate response to antimalarial agents in patients with cutaneous lupus erythematosus (CLE) using activity scores from the Cutaneous Lupus Erythematosus Disease Area and Severity Index, a validated outcome measure.
  
  
  METHODS
  Prospective, longitudinal cohort study.
  
  
  METHODS
  University cutaneous autoimmune disease clinic.
  
  
  METHODS
  A total of 128 patients with CLE who presented from January 2007 to July 2010 and had at least 2 visits with activity scores.
  
  
  METHODS
  Administration of antimalarial agents.
  
  
  METHODS
  Response was defined by a 4-point or 20% decrease in activity score. Response to initiation was determined by the difference between the scores before treatment and at the first visit at least 2 months after treatment. Response to continuation was determined by the difference between the scores at the first visit and the most recent visit while undergoing treatment.
  
  
  RESULTS
  Of 11 patients who initiated treatment with hydroxychloroquine, 55% were responders (n = 6), showing a decrease in median (interquartile range [IQR]) activity score from 8.0 (3.5-13.0) to 3.0 (1.8-7.3) (P = .03). Of 15 patients for whom hydroxychloroquine failed, 67% were responders to initiation of hydroxychloroquine-quinacrine therapy (n = 10), showing a decrease in median (IQR) activity score from 6.0 (4.8-8.3) to 3.0 (0.75-5.0) (P = .004). Nine of 21 patients who continued hydroxychloroquine treatment (43%), and 9 of 21 patients who continued hydroxychloroquine-quinacrine (43%) were responders, showing a decrease in median (IQR) activity score from 6.0 (1.5-9.5) to 1.0 (0.0-4.5) (P = .01) and 8.5 (4.25-17.5) to 5.0 (0.5-11.5) (P = .01), respectively.
  
  
  CONCLUSIONS
  The use of quinacrine with hydroxychloroquine is associated with response in patients for whom hydroxychloroquine monotherapy fails. Further reduction in disease activity can be associated with continuation of treatment with antimalarial agents.
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Aileen Y
authors.initials: AY
authors.lastname: Chang
authors.forename: Evan W
authors.initials: EW
authors.lastname: Piette
authors.forename: Kristen P
authors.initials: KP
authors.lastname: Foering
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Tenhave
authors.forename: Joyce
authors.initials: J
authors.lastname: Okawa
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Werth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006886:Hydroxychloroquine / Q000008:administration & dosage / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008178:Lupus Erythematosus, Cutaneous / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011796:Quinacrine / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials; D006886:Hydroxychloroquine; D011796:Quinacrine