title: Efficacy and comparison of antimalarials in cutaneous lupus erythematosus subtypes: a systematic review and meta-analysis.
abstract: BACKGROUND
  The antimalarials (AMs) hydroxychloroquine (HCQ) and chloroquine (CQ) have demonstrated variable cutaneous response rates in cutaneous lupus erythematosus (CLE).
  
  
  OBJECTIVE
  We sought to assess the global cutaneous response rates to HCQ and CQ, with respect to CLE subtypes, based on previously published studies.
  
  
  METHODS
  We performed a systematic review and meta-analysis of studies published in MEDLINE, Embase and the Cochrane Library between 1965 and December 2015. The proportions of responders to AMs according to CLE subtypes were extracted from individual studies and pooled using random-effects or fixed models. The odds ratio (OR) was used as the measure of association to compare the response rates between CLE subtypes and AMs.
  
  
  RESULTS
  Among 1990 courses of treatment with AMs from 31 included studies, the overall response rate to AMs was 63% [95% confidence interval (CI) 55-70], with important statistical heterogeneity across the included studies. HCQ had a higher overall efficacy than CQ, but this was not significant (OR 1·48, 95% CI 0·98-2·23). The response rate to AMs was different between CLE subtypes, ranging from 31% (95% CI 20-44) for chilblain lupus to 91% (95% CI 87-93) for acute CLE. The response was significantly higher for acute CLE than for subacute CLE and intermittent CLE. In case of failure of monotherapy with AM, the combination of quinacrine with HCQ or CQ seemed effective, whereas too little data were available to assess the efficacy of the switch to another AM agent.
  
  
  CONCLUSIONS
  Wide discrepancies in cutaneous response to AMs are observed between CLE subtypes. A specific therapeutic approach considering CLE subtypes may improve CLE management.
authors.affiliation: AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, 4 Rue de la Chine, Paris CEDEX 20, 75970, France.
authors.forename: F
authors.initials: F
authors.lastname: Chasset
authors.affiliation: AP-HP, Service de Dermatologie, Hôpital Saint Louis, Paris, F-75010, France.
authors.forename: J-D
authors.initials: JD
authors.lastname: Bouaziz
authors.affiliation: AP-HP, Université René Descartes Paris V, Paris, 75005, France.|Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Service de Médecine Interne Pôle Médecine, Hôpital Cochin, Paris, F-75014, France.
authors.forename: N
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.affiliation: AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, 4 Rue de la Chine, Paris CEDEX 20, 75970, France.
authors.forename: C
authors.initials: C
authors.lastname: Francès
authors.affiliation: Laboratoire d'ImmunoRhumatologie Moléculaire, Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, INSERM UMR_S1109, Université de Strasbourg, Strasbourg, F-67000, France.
authors.forename: L
authors.initials: L
authors.lastname: Arnaud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000627:therapeutic use*; D002738:Chloroquine / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D008178:Lupus Erythematosus, Cutaneous / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D056687:Off-Label Use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D003879:Dermatologic Agents; D006886:Hydroxychloroquine; D002738:Chloroquine