LONG-TERM EFFECTIVENESS OF ANTIMALARIAL-DRUGS IN RHEUMATIC DISEASES

Objective-The purpose of this study was to compare the long term effec tiveness between chloroquine (CQ) and hydroxychloroquine (HCQ). Method s - Medical charts of all patients seen by eight rheumatologists pract ising in two tertiary care centres and starting antimalarial treatment between January 1985 and December 1993 were reviewed. Patient charact eristics, disease, and treatment information were collected. The main outcome measures were the cause of and the time to the discontinuation of antimalarial drugs resulting from all causes, principally toxicity or inefficacy, or both. Bivariate analysis including t tests and chi( 2) tests were used to assess differences between means and proportions respectively. Survival curves were evaluated using the Kaplan-Meier m ethod. Multivariate analysis (Cox regression) was used to adjust for p otential confounders. Results - After all medical records were reviewe d, 1042 eligible cases were identified. From these, 940 (90%) had usab le information and they represent the cohort. Five hundred and fifty e ight had rheumatoid arthritis, 178 had systemic lupus erythematosus, 1 27 had palindromic arthritis, and 77 had other diagnoses. Fifty seven per cent of the patients received CQ and 43% HCQ. The proportion of pa tients with side effects taking HCQ and CQ was 15% and 28% respectivel y (p = 0.001). Using Cox regression model to adjust for age at the ons et of antimalarial treatment, physician differences, sex, disease type , disease duration before treatment, and rank selection, there were no differences in the hazard ratio (HR) for overall discontinuations bet ween CQ and HCQ. While the HR for discontinuations because of toxicity was lower for HCQ (HR = 0.6, 95% CI 0.4, 0.9), the HR for discontinua tions because of inefficacy was significantly higher for HCQ (HR = 1.4 , 95% CI 1.1, 1.9). Conclusions - After adjusting for time and several confounders HCQ was less toxic but less effective than CQ. Only one c ase of probable/possible retinopathy was found. Therefore, we propose a careful baseline ophthalmological evaluation by an expert and then o ne or every two years if proper doses are used.