Discontinuation of antimalarial drugs in systemic lupus erythematosus

Objective. To assess the reasons for and timing of discontinuation of antim alarial drugs, principally hydroxychloroquine (HCQ), in systemic lupus eryt hematosus (SLE). Methods, A lupus database was reviewed to identify antimalarial use from in ception to April 1996. Reasons for drug discontinuation were assessed by me dical record review. Results, Of 224 patients with SLE, 156 (70%) had received antimalarials. Th e 156 users received 203 courses of antimalarials, of which 197 (97%) were For HCQ. The average duration of use was 6.9 years/patient. Antimalarials w ere discontinued at least once in 62 patients. When only the first course o f use was considered, 67, 50, and 38% of patients continued to receive anti malarials at 5, 10, and 15 years, respectively (for all courses, the rates were 82, 66, and 52%, respectively). Reasons for discontinuation were disea se remission in 26 (42%), side effects in 18 (29%), noncompliance in 9 (15% ), lack of efficacy in 5 (8%), and miscellaneous causes such as pregnancy/s urgery in 4 (6%). When all courses were considered, 20 subjects were withdr awn for side effects, including gastrointestinal in 11: headache and dizzin ess, and nonretinal eye problem in 2 each; and hearing loss and rash in one each. Two developed HCQ myopathy (1.9 cases/1000 patient-years of HCQ ther apy. 95% CI 0.2, 7.0). One developed HCQ retinopathy after 6 years: at a do se of 6.5 mg/kg/day (0.95 cases/1000 patient-years of HCQ; 95% CI 0.0, 5.5) . Among patients who had received HCQ for at least 6 years, 1.3% developed retinopathy (95% CI 0.03. 7.0%). Conclusion. HCQ is well tolerated in SLE. However, ophthalmologic testing r emains essential, as retinopathy does occur, albeit rarely.