Hydroxychloroquine and systemic lupus: a reappraisal

Purpose. - Hydroxychloroquine (HCQ) is still too often considered as a second-line treatment in systemic lupus erythematosus (SLE) patients. Key points. - Recently, interest for this drug has grown as a consequence of its favorable efficacy/toxicity ratio, its low cost and the availability of a blood measurement assay. Its efficiency has been demonstrated in the reduction of the risk of SLE flares and of overall damage accrual. The properties of HCQ also include a beneficial effect on lipid profile, and a protective effect against the occurrence of thrombotic events and of low bone mineral density related to corticosteroids. As a consequence, HCQ appears to have a protective effect on survival in people with SLE. Side-effects and contraindications are rare. Even if the incidence of retinopathy in clinical practice is very low, regular screening of this complication is required, but its modalities are not consensual. Conclusion. - These data are strong evidence for a wide prescription of HCQ. This should easily improve the management of our SLE patients. (C) 2007 Elsevier Masson SAS. Tons droits reserves.