OKLAHOMA CITY, Oklahoma—Catching lupus early and treating it with hydroxychloroquine may delay or prevent the onset of systemic lupus erythematosus (SLE) in certain high risk individuals, according to provocative new findings in the journal Lupus.¹

"We can't yet give a clear answer as to which ‘high risk' individuals should be treated with hydroxychloroquine for prevention [but] we think this study provides provocative supportive evidence that a prospective trial of hydroxychloroquine in a high risk group is warranted, [and] work is under way to help define the best high risk individuals for study," lead study author Judith James, MD, PhD, the Lou X. Kerr Chair in Biomedical Research, and a professor of medicine at the University of Oklahoma Health Sciences Center, in Oklahoma City, tells CIAOMed.

Of 130 US military personnel who later met four American College of Rheumatology criteria for SLE, 26 were treated with hydroxychloroquine prior to diagnosis and had a longer lag time between the onset of their first clinical symptom and SLE classification than did those participants who did not receive hydroxychloroquine. Generally used to manage nonorgan threatening lupus, hydroxychloroquine has been shown in some studies to reduce flares and lupus-related disease activity and damage.

Is hydroxychloroquine a DMARD for SLE?

Specifically, the group treated with hydroxychloroquine developed SLE in about 1.08 years, compared with 0.29 years among their counterparts who did not receive the early treatment. Patients treated with hydroxychloroquine also had a lower rate of autoantibody accrual than patients who did not take the antimalarial before their SLE diagnosis.

"Individuals were treated with hydroxychloroquine before four criteria SLE classification for a variety of reasons, such as rashes, discoid lesions, polyarthritis, or a combination of lupus-like symptoms," Dr. James said. Seventeen of these patients received hydroxychloroquine after their first symptom and eight patients received it at onset of their first symptom. Just one patient received the antimalarial before their first symptom appeared.

Patients who had received both prednisone and hydroxychloroquine also had a longer lag time between symptoms and SLE diagnosis than their counterparts who only received prednisone, the study showed. This suggests that it's the antimalarial that makes the difference, but synergistic effects may also be influential.

Patients treated with prednisone before diagnosis also were diagnosed with SLE later than counterparts who did not receive steroids prior to diagnosis. Nonsteroidal anti-inflammatory drug use did not affect time to SLE diagnosis, the study showed.

The new findings warrant a prospective trial, the study authors state. "This prospective evaluation would provide clinical evidence to evaluate the potential role of hydroxychloroquine in modifying development of SLE and to identify modifiable risk factors in this context," they conclude. "Those who develop severe SLE while on hydroxychloroquine might provide further biologic clues to markers predictive of need for (and to justify the study of) more aggressive preventative therapies."

Hydroxychloroquine full of surprises after all these years

"This is an interesting study and interesting approach," said Robert Eisenberg, MD, rheumatologist at the University of Pennsylvania, in Philadelphia, and a member of the Lupus Research Institute's scientific advisory board.
 
"Their findings look pretty robust, but whether they could be repeated in another population, I don't know. This drug has surprised us before in terms of its effectiveness," he said.

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