Hydroxychloroquine may benefit some RA patients if combined with other drugs
medwireNews: Hydroxychloroquine may offer a degree of clinical benefit to patients with rheumatoid arthritis (RA) when used in combination with conventional synthetic (cs)DMARDs, suggest the results of a systematic review.
However, the study authors, led by Claire Rempenault from Montpellier University in France, say that it is difficult to draw firm conclusions because of a high degree of heterogeneity in the treatment doses and main outcomes used in the 11 studies they reviewed.
In a previous systematic review and meta-analysis, Rempenault and team demonstrated that hydroxychloroquine “may benefit lipid profiles and diabetes incidence and to a lesser extent, [cardiovascular] events and insulin resistance in patients with RA,” but they say there is a lack of data evaluating the clinical and structural benefit of the antimalarial agent for joints in patients with RA.
The current review, involving 104,278 patients, included six studies comparing hydroxychloroquine monotherapy with methotrexate (n=2 studies) or sulfasalazine (n=4) among patients who typically had a disease duration of less than 5 years and were naïve to treatment with csDMARDs.
In all six studies, the clinical and structural efficacy of hydroxychloroquine was similar to or lower than that of the comparator, which suggests that hydroxychloroquine “should not be considered as monotherapy for the majority of patients with early RA,” Rempenault et al remark.
Six studies, including one which also investigated hydroxychloroquine monotherapy, evaluated hydroxychloroquine in combination with another csDMARD in patients with established RA (disease duration >5 years) who had an insufficient response to csDMARDs.
Of these, three studies evaluated the combination of hydroxychloroquine with methotrexate versus methotrexate alone, one of which showed a greater improvement in DAS28 scores in the combination group among patients with early RA.
The second study showed that remission was more common with hydroxychloroquine used in combination with methotrexate and triamcinolone than with methotrexate alone, while the third study showed a similar odds of achieving a modified ACR20 response rate at 12 months among patients who received hydroxychloroquine plus methotrexate and those who received methotrexate alone.
One trial compared hydroxychloroquine plus sulfasalazine with sulfasalazine alone, and another compared hydroxychloroquine plus leflunomide with leflunomide alone. Neither found any additional benefit with hydroxychloroquine.
By contrast, a randomized trial of methotrexate and sulfasalazine with or without hydroxychloroquine showed that ACR20 and ACR50 response rates at 2 years were significantly higher with than without hydroxychloroquine.
Rempenault et al conclude in Arthritis Care & Research that “[hydroxychloroquine] could be used in combination with other csDMARDs for some RA patients.”
They continue: “The known metabolic and protective cardiovascular effects of hydroxychloroquine as well as its low cost and good safety profile are arguments strengthening this hypothesis,” but stress that “recent and well-conducted studies are warranted to support this conclusion.”
By Laura Cowen
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