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The role of antimalarial agents in the treatment of SLE and lupus nephritis

Nature Reviews Nephrology volume 7, pages 718–729 (2011)Cite this article

Subjects

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that affects various organs. Lupus nephritis is one of the most common, and most important, serious manifestations of SLE. Antimalarial agents are part of the immunomodulatory regimen used to treat patients with SLE; however, their role in the treatment of patients with lupus nephritis in particular is less well recognized, especially by nephrologists. Not all antimalarial agents have been used in the treatment of lupus; this Review will focus on studies using chloroquine and hydroxychloroquine. In addition, this Review will briefly describe the history of antimalarial drug use in patients with SLE, the theorized mechanisms of action of the agents chloroquine and hydroxychloroquine, their efficacy in patients with SLE and those with lupus nephritis, their use in pregnancy, and potential adverse effects. The Review will also cover the latest recommendations regarding monitoring for hydroxychloroquine-associated or chloroquine-associated retinopathy. Overall, antimalarial drugs have numerous beneficial effects in patients with SLE and lupus nephritis, and have a good safety profile.

Key Points

  • Antimalarial therapy for patients with systemic lupus erythematosus (SLE) is associated with improved survival and reduced disease activity, as well as cardioprotective and anticancer effects

  • In lupus nephritis, antimalarial therapy is associated with reduced corticosteroid use, reduced disease activity, extended time to end-stage renal disease, and, with adjunctive immunomodulatory treatment, improved duration of renal remission

  • Treatment with antimalarial agents should be continued in pregnant women with SLE; the beneficial effects may include a reduction in the risk of cardiac manifestations of neonatal SLE

  • Antimalarial drugs have a good safety profile; gastrointestinal symptoms are the most common adverse effect

  • Baseline monitoring for retinopathy is required, but regular monitoring is recommended by the American Academy of Ophthalmology guidelines only for patients who have taken antimalarial agents for >5 years

  • In patients with impaired renal function, caution with dosing of antimalarial agents is recommended and careful monitoring for adverse events should be undertaken

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Authors and Affiliations

  1. Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, ON, Canada

    Senq-J Lee & Earl Silverman

  2. Department of Medicine, Division of Nephrology, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, M5G 2C4, ON, Canada

    Joanne M. Bargman

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  1. Senq-J Lee
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  2. Earl Silverman
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  3. Joanne M. Bargman
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Contributions

S-J. Lee and E. Silverman researched the data for the article. S-J. Lee and J. M. Bargman were the principal contributors to writing the article and discussing its content, although E. Silverman was also involved in these aspects of the manuscript. J. M. Bargman, and to a lesser extent S-J. Lee, participated in the review and/or editing of the manuscript before submission.

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Correspondence to Joanne M. Bargman.

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Lee, SJ., Silverman, E. & Bargman, J. The role of antimalarial agents in the treatment of SLE and lupus nephritis. Nat Rev Nephrol 7, 718–729 (2011). https://doi.org/10.1038/nrneph.2011.150

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