ANTIMALARIAL DRUG-INDUCED DECREASE IN CREATININE CLEARANCE

Objective. To confirm the antimalarial drug induced increase of creati nine to determine the factors contributing to this effect. Methods. Pa tients with rheumatoid arthritis (RA) (n = 118) who have used or still use antimalarials (chloroquine or hydroxychloroquine). Serum creatini nes prior to antimalarials and serum creatinines during antimalarials were recorded and the creatinine clearance was estimated. Results. The mean creatinine clearance decreased from 99 ml/min to 92 ml/min (p <0 .001) after the start of antimalarial drugs. Fifty-five percent of the patients with chloroquine compared to 15% of the patients with hydrox ychloroquine (chi(2) = 17.8; p <0.001) had more than 10% decrease of t he creatinine clearance. Age (beta = 0.004; p = 0.0002) and the kind o f antimalarial (beta = 0.095; p = 0.0002) were strong independent pred ictors of the decrease of the creatinine clearance in the multiple reg ression analysis. For patients using chloroquine the mean age adjusted decrease of creatinine clearance was 11.2%. Conclusion. Antimalarials cause a significant reduction of the creatinine clearance. The use of chloroquine and older age were associated with decreased creatinine c learance. Whether antimalarials affect glomerular filtration or tubula r excretion of creatinine remains to be investigated.