title: Hydroxychloroquine: a multifaceted treatment in lupus.
abstract: The efficacy of antimalarials, especially hydroxychloroquine (HCQ), in preventing systemic lupus erythematosus (SLE) flares is well demonstrated. However, many studies show that the percentage of SLE patients treated with HCQ remains low. By blocking the toll-like receptor 7 and 9 in plasmacytoid dendritic cells, HCQ inhibits interferon-alpha production which plays a crucial role in SLE pathogenesis. In addition to reducing damage accrual in SLE patients, HCQ appears to protect against the occurrence of diabetes, thrombotic events, and dyslipidemia. As a consequence, some studies have suggested that HCQ, which is inexpensive, has a protective effect on survival in SLE patients. Thanks to the pharmacokinetic properties of HCQ (long half-life) and to the availability of its blood assay, very low or undetectable blood HCQ concentrations are a valuable marker of non-adherence to treatment, thus adding a new benefit to HCQ prescriptions. The main side effect of HCQ is retinal toxicity. This complication is very rare, but may be potentially severe, thus requiring regular screening. Retinal toxicity remains the only absolute contra-indication of HCQ in adult SLE patients. Other contra-indications are few and rare. During pregnancy and breast-feeding, HCQ continuation is not only allowed but recommended. In conclusion, the risk/benefit ratio of HCQ is excellent. Many now believe that all SLE patients should be offered this treatment.
authors.affiliation: AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France. Electronic address: nathalie.costedoat@gmail.com.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.affiliation: AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dunogué
authors.affiliation: AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Morel
authors.affiliation: AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Le Guern
authors.affiliation: Université de Clermont-Ferrand, CHU de Clermont-Ferrand, hôpital Gabriel-Montpied, service de médecine interne, 63003 Clermont-Ferrand, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Guettrot-Imbert
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D006207:Half-Life; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D016898:Interferon-alpha / Q000037:antagonists & inhibitors; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000517:prevention & control; D055118:Medication Adherence; D012164:Retinal Diseases / Q000139:chemically induced; D051199:Toll-Like Receptor 7 / Q000037:antagonists & inhibitors; D051217:Toll-Like Receptor 9 / Q000037:antagonists & inhibitors
chemical_list: D000962:Antimalarials; D018501:Antirheumatic Agents; D015415:Biomarkers; D016898:Interferon-alpha; C495348:TLR7 protein, human; C495371:TLR9 protein, human; D051199:Toll-Like Receptor 7; D051217:Toll-Like Receptor 9; D006886:Hydroxychloroquine