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Hydroxychloroquine reduces risk of kidney damage in lupus

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Long-term treatment of systemic lupus erythematosus (SLE) with hydroxychloroquine, initiated soon after disease onset, is protective against renal damage, according to study findings presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco.

“We have shown before that hydroxychloroquine protects several organ systems in patients with lupus,” co-investigator Dr. Graciela Alarcon told Reuters Health. “The question remained, does hydroxychloroquine also prevent the development of kidney damage, one of the most serious complications of SLE? This is important to know, since patients with renal damage may need a kidney transplant or dialysis, which increase health care costs and impact patients’ quality of life.”

The research team studied 582 patients with disease duration no longer than 5 years at baseline; 506 were treated with hydroxychloroquine.

Seventy-three patients developed renal damage — defined as diminished renal function, end-stage renal disease, or proteinuria lasting at least 6 months — after a mean disease duration of 5.5 years.

After adjusting for variables associated with hydroxychloroquine treatment, the drug remained highly protective against the occurrence of renal damage (adjusted hazard ratio 0.31, p = 0.0002).

Dr. Alarcon, from the University of Alabama at Birmingham, noted that in a separate cohort of patients who already had lupus nephritis, hydroxychloroquine was similarly protective against further renal damage.

“We observed comparable results in those with and without nephritis,” she said, amounting to a 70% reduction in risk.

She speculates that the benefits of hydroxychloroquine treatment result from the combination of its antiinflammatory, antithrombotic, antihyperlipidemic, and antihyperglycemic effects. She emphasized that hydroxychloroquine may prevent kidney damage but it does not reverse damage that is already present.

“Our data strongly suggest that if renal damage is to be prevented, hydroxychloroquine should be prescribed to all lupus patients early in the course of the disease,” the research team concludes.

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American College of Rheumatology