Antimalarial medications have been highly effective in treating various rheumatic diseases and related conditions. Hydroxychloroquine, Chloroquine, and Quinacrine are antimalarial medications that are primarily used to treat lupus due to their safety profile. Lupus is a chronic inflammatory condition with unpredictable flares and symptoms, which include joint pain, skin rash, fatigue, muscle aches, and weakness.
When learning that antimalarial medications are used for lupus treatment, many people wonder why. The answer is that most drugs have more than one indication or application. While there are similarities, the manner that antimalarial medications work for treating malaria is not necessarily identical for lupus.
How do antimalarial medications work for lupus?
Lupus is an autoimmune condition, meaning a condition where the body’s immune system attacks healthy cells. The same immune cells that fight the invading pathogen attacks our own cells. This causes inflammation and other symptoms to develop that affect various parts of the body. Chloroquine inhibits the immune cells from regenerating out of control. It achieves this by influencing the ability of cells to absorb and process thymine, the building block of DNA needed to replenish new cells.
Hydroxychloroquine is the residual product of Chloroquine, but is also useful as a treatment. In fact, Hydroxychloroquine is the most common antimalarial medication used for lupus. Interferon is a protein that helps fight off viruses. It can also cause a major inflammation in people with lupus. Hydroxychloroquine inhibits the production of interferon while maintaining a proper balance between protecting the body from viruses and protecting the body from flares.
What are benefits of Hydroxychloroquine in lupus?
Several studies have noted a broad benefit of using Hydroxychloroquine.
- Decrease in the damage caused by disease over time
- Reduction in the number of flares
- Delayed absorption of ultraviolet light, improving skin rashes and reducing flares
- Strong evidence of decreased lupus activity during pregnancy, and no harm to the unborn baby
- Strong evidence of long-term survival and prevention of disease flares
Smoking makes Hydroxychloroquine less effective, reducing benefits to people who smoke.
What are adverse effects of Hydroxychloroquine and other antimalarials?
Antimalarials are among the safest medications used in the treatment of lupus. Serious side effects are extremely rare.
Common side effects of antimalarial medications (more so with Chloroquine) include nausea, vomiting and diarrhea. Taking the medication at bedtime may lessen these gastrointestinal symptoms.
Long-term therapy with Chloroquine and Hydroxychloroquine may cause hyperpigmentation (patches of skin that are darker than surrounding skin) usually involving shins, nails and forearms.
Hydroxychloroquine may exacerbate or precipitate psoriasis.
Quinacrine causes reversible yellowing of skin, or black and blue marks on the palate in some people.
Headache and lightheadedness may occur with antimalarials. Other potential problems involving the nervous system include insomnia, tinnitus, and increased nervousness.
The most feared adverse effect of antimalarial medications is the effect on vision. Although extremely rare, antimalarials may lead to permanent vision loss. The American College of Rheumatology (ACR) recommends that all people starting Hydroxychloroquine and other antimalarial medications get a baseline complete eye examination within the first year of treatment and an annual eye examination thereafter.
Other rare side effects of long-term Chloroquine and Hydroxychloroquine use are heart rhythm disorders, heart failure and cardiac arrest.
Reduction in white blood cells, red blood cells and platelets, though extremely rare, may occur with the use of antimalarial medications.
Is Hydroxychloroquine effective for treating or preventing coronavirus (COVID-19)?
Hydroxychloroquine is not approved by Food and Drug Administration (FDA) for the treatment of COVID-19. The best available evidence, based on number of studies conducted, have shown that Hydroxychloroquine is not effective in the treatment and prevention of COVID-19. The FDA revoked their earlier approval of emergency use authorization (EUA) for Hydroxychloroquine.
Follow all necessary precautions to avoid getting Covid-19 whether you are taking Hydroxychloroquine or not. Hydroxychloroquine is ineffective in preventing the contraction of coronavirus.
Hydroxychloroquine and other antimalarial medications are in a class by themselves, compared to other lupus treatment options. By not being immunosuppressants, they decrease the likelihood of infection. Hydroxychloroquine has shown to improve outcomes in people with lupus.
Adhering to your doctor’s prescribed medication protocol and maintaining a healthy lifestyle are important in managing lupus symptoms and reducing its flares.