With Antimalarials in Lupus, Watch for Retinal Toxicity

Antimalarials have a long history of use in lupus, Rosenbaum explained, going back at least to the 1950s, and have proved extremely valuable in treating the condition. A major study published in 2007 called LUMINA demonstrated that not only did HCQ relieve many lupus symptoms, it also had a protective effect on survival, with an odds ratio of 0.128 (95% CI 0.054 to 0.301) compared with patients not on the drug. More recently, another study showed that combining HCQ with aspirin reduced cardiovascular events and mortality versus either drug alone and most dramatically versus neither. How antimalarials work in lupus isn't entirely clear, but Rosenbaum listed a number of effects that likely contribute: inhibition of lysosomal enzymes and elements in the complement pathway, reductions in lipids and thrombotic factors, and spurring apoptosis of autoreactive T and B cells. The effect, he said, is to "modify the immune response without impairing normal immunity." "Anyone who can tolerate an antimalarial should be on an antimalarial," he said flatly. https://www.medpagetoday.com/meetingcoverage/acrsota/72389?xid=nl_mpt_DHE_2018-04-18&eun=g721819d0r&pos=0&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202018-04-18&utm_term=Daily%20Headlines%20-%20Active%20User%20-%20180%20days