Anti-malarials: Are There Benefits Beyond Mild Disease?

Abstract

Therapeutic applications for hydroxychloroquine, a quinine compound originally used as an anti-malarial, have evolved and expanded over the years to include the treatment of autoimmune rheumatic diseases. In systemic lupus erythematosus (SLE), hydroxychloroquine has emerged as a cornerstone medication for not only mild disease but also severe disease as adjunctive therapy. With the advent of highly effective biologic disease-modifying agents over the last two decades for treatment of rheumatoid arthritis (RA), hydroxychloroquine's future in RA is less clear. However, hydroxychloroquine's pleiotropic benefits in rheumatic diseases have been increasingly recognized, supporting its place in the therapeutic armamentarium. These benefits include but are not limited to its beneficial impact on glycemic and lipid profiles and its anti-thrombotic effects. These are of major significance in light of the great burden of cardiovascular morbidity and mortality in patients with lupus and RA. This relatively safe, inexpensive, and generally well-tolerated medication's uncommon but serious risk is retinal toxicity which can be minimized by following screening and monitoring guidelines and using appropriate weight-based dosage. In this review article, we present an overview of hydroxychloroquine's potential role beyond its anti-rheumatic benefits. Copyright © 2016, Springer International Publishing AG.