EFFECTIVENESS OF CHLOROQUINE AND HYDROXYCHLOROQUINE IN TREATING SELECTED PATIENTS WITH SARCOIDOSIS WITH NEUROLOGICAL INVOLVEMENT

Objective: To assess the efficacy of chloroquine (Aralen) phosphate an d hydroxychloroquine (Plaquenil) sulfate in the treatment of patients with neurosarcoidosis who either do not respond to corticosteroid ther apy or develop unacceptable side effects. Design: Retrospective study. Setting: Sarcoidosis clinic at a university teaching hospital. Patien ts: Twelve patients with biopsy-proved sarcoidosis, 6 women and 6 men ranging from 20 to 49 years of age, with neurological involvement. Int ervention: Chloroquine phosphate, 250 mg twice daily, or hydroxychloro quine sulfate, 200 mg twice daily, was administered for a period of 6 to 21 months. Patients had regular clinical evaluation, determination of serum and cerebrospinal fluid angiotensin-converting enzyme level, computed tomography or magnetic resonance imaging, chest radiography, lung function testing, and slit-lamp examination of the eyes. Results: Chloroquine or hydroxychloroquine either stabilized symptoms or contr olled neurological symptoms in 10 of 12 patients. Two patients failed to respond. Cerebrospinal fluid abnormalities, including lymphocytosis , were seen in 3 patients. Magnetic resonance imaging with gadolinium was most helpful in supporting the diagnosis of sarcoidosis and monito ring the course of the disease. Conclusions: Chloroquine and hydroxych loroquine are effective in controlling neurological sarcoidosis in tho se patients who fail to respond to corticosteroids or develop severe s ide effects. Ocular toxic effects from chloroquine or hydroxychloroqui ne were not observed.