The cholesterol lowering effect of antimalarial drugs is enhanced in patients with lupus taking corticosteroid drugs

Objective. To examine the relationship between antimalarial therapy and tot al cholesterol in patients with systemic lupus erythematosus (SLE) with or without steroid therapy. Methods. Retrospective study for the University of Toronto Lupus Clinic dat abase between 1976 and 1997, The effects of antimalarials on random total c holesterol levels were assessed in the following situations: patients not r eceiving steroids (part I) that either initiated or discontinued antimalari als; patients receiving steroids (part II) that were either on a stable dos e or initiating antimalarials; and patients initiating steroids with or wit hout antimalarials (part III). Paired t test, Fisher's exact test, and 2 wa y analysis of variance were used when appropriate. Results. Initiation of antimalarials reduced the baseline total cholesterol by 4.1% at 3 months in 53 patients (p = 0.020) and by 0.6% at 6 months in 30 patients (p = NS), while the cessation of anti malarials increased the t otal cholesterol by 3.6% at 3 months in 38 patients (p = NS) and 5.4% at 6 months in 22 patients (p = NS). In 181 patients taking steroids and antimal arials, the mean total cholesterol was 11% less than for 201 patients recei ving a comparable dose of steroids alone (p = 0.0023). Initiation of antima larials on a stable dose of steroids reduced the total cholesterol by 11.3% at 3 months in 29 patients (p = 0.0002) and 9.4% at 6 months in 20 patient s (p = 0.004). For patients initiating steroids, the percentage increase in cholesterol was lower in those taking antimalarials compared to patients w ithout antimalarial therapy (p = 0.0149). Conclusion. Antimalarials lower total cholesterol in patients receiving ste roids and may minimize steroid induced hypercholesterolemia.