Long-term use of antimalarial drugs in rheumatic diseases

To evaluate long-term use of antimalarial drugs and to analyse all causes of discontinuation. This is a retrospective study of a cohort of rheumatic diseases patients on antimalarials, during a maximum period of 17.5 years. Case was defined as antimalarial treatment discontinuation due to: a) lack o...

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Bibliographic Details
Published in:Clinical and experimental rheumatology 2012-05, Vol.30 (3), p.380-387
Main Authors: JOVER, J. A, LEON, L, PATO, E, LOZA, E, ROSALES, Z, MATIAS, M. A, MENDEZ-FERNANDEZ, R, DIAZ-VALLE, D, BENITEZ-DEL-CASTILLO, J. M, ABASOLO, L
Format: Article
Language:English
Subjects:
Adult
Aged
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimalarials - administration & dosage
Antimalarials - adverse effects
Antiparasitic agents
Antirheumatic Agents - administration & dosage
Antirheumatic Agents - adverse effects
Biological and medical sciences
Chloroquine - administration & dosage
Chloroquine - adverse effects
Comorbidity
Diseases of the osteoarticular system
Female
Follow-Up Studies
Humans
Hydroxychloroquine - administration & dosage
Hydroxychloroquine - adverse effects
Male
Medical sciences
Middle Aged
Miscellaneous. Osteoarticular involvement in other diseases
Pharmacology. Drug treatments
Retrospective Studies
Rheumatic Diseases - drug therapy
Rheumatic Diseases - epidemiology
Risk Factors
Time
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Summary:To evaluate long-term use of antimalarial drugs and to analyse all causes of discontinuation. This is a retrospective study of a cohort of rheumatic diseases patients on antimalarials, during a maximum period of 17.5 years. Case was defined as antimalarial treatment discontinuation due to: a) lack of efficacy, b) adverse events, and c) other causes. Survival techniques were used to estimate the incidence rate (IR) per 1,000 patient-years with the 95% Confidence Interval (95% CI) of antimalarial treatment discontinuation. Cox regression models were conducted to evaluate possible associated factors to antimalarial discontinuation. One thousand, two hundred and ninety-one medical records were reviewed, and 778 patients were included. Patients started 869 different courses of treatment, with a total follow-up of 2,263 person-years. The IR of global discontinuation was 204 (95% CI 186-224). Fifty-two per cent of the treatments stopped were related to adverse events, 14% to lack of efficacy; and 34% to other reasons (refusal to take medication, ocular comorbidity, remission, or pregnancy). Adverse events discontinuations were related to non-ophthalmologic reasons in 54.5% (gastrointestinal, neuro-psychiatric, skin problems), and to ophthalmologic adverse events in 45.5%. Nine patients suffered definite presence of antimalarial retinopathy (IR: 3.97 [IC 95%: 2.06-7.62]) and one of them irreversible loss of vision (IR: 0.44 [IC 95%: 0.06-3.12]). Women, increasing age, and chloroquine vs. hydroxychloroquine use, increased the risk of discontinuation due to ophthalmologic adverse events. Results suggest that antimalarials have a good balance between benefit and risk. However, we noted a number of discontinuations due to both inefficacy and adverse events. The potential for an unusual but serious ophthalmologic toxicity emphasises the importance of close ophthalmologic monitoring.
ISSN:0392-856X
1593-098X