Review
Hydroxychloroquine in systemic and autoimmune diseases: Where are we now?
AlinaDimaa
CiprianJurcutb
LaurentArnaudcde
a
Department of rheumatology, Colentina clinical hospital, 020125 Bucharest, Romania
b
Department of internal medicine, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
c
National reference centre for rare auto-immune and systemic diseases Est Sud-Est (RESO), 67000 Strasbourg, France
d
Department of rheumatology, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
e
Université de Strasbourg, Inserm UMR-S 1109, 67000 Strasbourg, France
Accepted 23 December 2020, Available online 28 January 2021.
doi.org/10.1016/j.jbspin.20... rights and content
Highlights
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Hydroxychloroquine (HCQ) has been used in a wide range of pathologies, including infectious diseases, immune disorders, diabetes and dyslipidemia.
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HCQ is the mainstay of treatment for systemic lupus erythematosus (SLE), where, according to last European guidelines, it should be proposed to all patients.
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There are no strong data to support the use of HCQ in other systemic diseases.
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In rheumatoid arthritis, its role is limited, especially due to the lack of structural damage prevention.
Abstract
Hydroxychloroquine (HCQ), one of the oldest drugs used in rheumatology, came recently into attention as one of the potential therapies tested for the severe acute respiratory syndrome coronavirus-2 disease treatment. Used initially as an antimalarial, then translated to rheumatic diseases, HCQ has been used in a wide range of pathologies, including infectious diseases, immune disorders, diabetes, dyslipidemia, or neoplasia. Regarding systemic diseases, HCQ is the mainstay treatment for systemic lupus erythematosus (SLE), where, according to last European guidelines, it is proposed to all SLE patients unless contraindicated or with side effects. HCQ proved positive impact in SLE on robust outcomes, such as accrual damage, disease activity and survival, but also pleiomorphic effects, including decrease in the need for glucocorticoids, reduction in the risk of neonatal lupus, lower fasting glucose and protection against diabetes, thrombotic risk, dyslipidemia, infections, etc. Moreover, HCQ can be used during pregnancy and breast-feeding. Besides SLE, the role for HCQ in the anti-phospholipid syndrome and Sjögren's disease is still under debate. On the contrary, recent advances showed only limited interest for rheumatoid arthritis, especially due the lack of structural damage prevention. There are still no strong data to sustain the HCQ use in other systemic diseases. In this review, we summarised the utility and efficacy of HCQ in different clinical conditions relevant for rheumatology practice.
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