The benefit of combining hydroxychloroquine with quinacrine in the treatment of SLE patients

Background: Although the benefit of antimalarials in the treatment of cutan eous LE is well established, the effect of combined hydroxychloroquine and quinacrine treatment in systemic lupus erythematosus with major organ invol vement remains underappreciated. Patients: Six active SLE patients (SLEDAI score > 5 points), with a mean du ration of illness 9.1 yr (range 2-17 yr) were started on quinacrine (100 mg /d) following failure to achieve clinical remission on a therapeutic regime n which included a maintenance dose of hydroxychloroquine (400 mg/d) togeth er with prednisone (either 10-20 mg/d or higher daily doses of this agent f or short periods) and azathioprine (150 mg/d) or methotrexate (7.5 mg/week) . Outcome: In 5/6 of the patients the addition of quinacrine to the previous treatment resulted in complete remission (SLEDAI 0-2 points), which persist ed over the follow-up period [mean +/- 2.2 yr (range 0.5-3.5)]. During this period hydroxychloroquine and azathioprine were reduced to 200 mg/d and 10 0 mg/d respectively, whereas prednisone was modified as follows: in 2 patie nts daily administration was discontinued; in one the dose was reduced to 2 .5 mg/d (from that of greater than or equal to 20 mg/d); in 2 others the pr evious need for an intermittent course was avoided. However, in one out of the six patients the addition for 3 months of quinacrine to the therapeutic protocol did not result in clinical improvement and was therefore disconti nued. Conclusions: The promising results of this preliminary investigation encour ages the combined use of the two antimalarial drugs in appropriate candidat es. This modality may induce remission, seems to be safe and possesses a st eroid sparing effect.