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Quinacrine + Hydroxychloroquine Effective in Cutaneous Lupus

Continuation of hydroxychloroquine, combo therapy effective in CLE patients initially failing monotherapy

THURSDAY, July 21 (HealthDay News) -- Patients with cutaneous lupus erythematosus (CLE) who fail to respond to hydroxychloroquine alone may respond to the addition of quinacrine, but may also benefit from continuation of hydroxychloroquine monotherapy despite initial lack of response, according to a study published online July 18 in the Archives of Dermatology.

Aileen Y. Chang, from the Philadelphia Veterans Affairs Medical Center, and colleagues investigated the effects of antimalarial agents in 128 patients with CLE between 2007 and 2010 using activity scores from the Cutaneous Lupus Erythematosus Disease Area and Severity Index. All of the patients had at least two visits with activity scores, and their responses were defined by a four-point or 20 percent decrease. Response to the initiation of treatment was measured by the difference between the scores before treatment and at the first visit at least two months after treatment. Response to the continuation of treatment was measured by the difference between the scores at the first visit and the most recent visit during treatment.

The investigators found that six of 11 patients who initiated hydroxychloroquine therapy while enrolled in the database responded to treatment, corresponding to a significant decrease in the median activity score from 8.0 to 3.0. For the 15 patients who had failed to respond to hydroxychloroquine treatment, 10 patients responded to hydroxychloroquine-quinacrine therapy with a significant decrease in median activity score from 6.0 to 3.0. Nine out of 21 patients who continued hydroxychloroquine, as well as nine out of 21 patients who continued hydroxychloroquine-quinacrine, responded to treatment, both showing a significant decrease in the median activity score, from 6.0 to 1.0 and 8.5 to 5.0, respectively.

"This prospective study provides evidence supporting the use of hydroxychloroquine-quinacrine for treating patients with CLE who do not respond to hydroxychloroquine," the authors write. "It also demonstrates that continuing hydroxychloroquine or hydroxychloroquine-quinacrine treatment can be beneficial, even in the absence of initial response."

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