Hydroxychloroquine - Risks and Benefits in Lupus

Benefits:

↓ Disease activity, ↓ Flare, ↓ Damage, ↓ Corticosteroid dose, ↓ Mortality, ↓ Thrombosis, ↓ Severe infection, ↓ Hyperlipidemia, ↓ SSA-associated fetal block, ↓ Cardiovascular risk, ↓ Polyautoimmunity 

Risks:

 - Retinopathy: 2-3% of patients, usually after 5-20 years [monitoring needed)

 - Digestive intolerance nausea, diarrhea, bloating [common]

 - Prolonged QTc (association not recommended with other medications leading to prolonged QT) [very rare if no interaction]

 - Cardiomyopathy [very rare with ~100 cases reported and usually after many years, usually severe]: conduction abnormalities and/or cardiac insufficiency

 - Cuteanous: acute generalized exanthematous pustulosis (AGEP) [rare but usually severe], pruritis and aquagenic urticaria [quite common], hyperpigmentation [usually after years]

 - Hematological: cytopenia, agranulocytosis [rare, should be known by doctors]

 - Neuro-muscular: vacuolar myopathy [rare to very rare: due to muscular accumulation], extrapyramidal manifestations [exceptionall

 - Hypoglycaemia [very uncommon but should be known by physicians]

 - Worsening of other diseases: myasthenia gravis [use with caution] and G6PD deficiency [(limited) risk of hemolysis], psoriasis [can worsen], porphyria [can flare]

 - Dose adaptation needed in case of renal or hepatic insufficiency

 - Tinnitus & eye accommodation problems (check cinchonism)



Dr. Laurent ARNAUD @Lupusreference



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