Should Antimalarial Drugs Such as Hydroxychloroquine Be Used in People with Systemic Lupus Erythematosus
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What did we find?

78 experts were identified. There were 24 from Canada, 31 from the United States, 5 from Mexico and 18 from the United Kingdom. Out of 78, 74% relied to the questionnaire. Three-quarters of those who replied were male physicians and their average age was 51 years old. The typical doctor who replied followed at least 75 people with SLE each and had four or five of their patients become pregnant every year. Survey results found:

  • 42% said they often or always continued antimalarials drugs during pregnancy,
  • 27% said sometimes,
  • and 32% said never or rarely.
  • The more pregnant persons with SLE that the individual physician cared for, the more likely they were to continue hydroxychloroquine in pregnancy. Also, the more recently the individual had graduated from medical school, the more likely they were to continue the hydroxychloroquine. Those physicians who tended to continue hydroxychloroquine during pregnancy were also significantly more likely to start hydroxychloroquine during pregnancy for a flare-up in women who were not taking it. None of the physicians reported having ever seen any problems to a baby with antimalarial use. When the issue of breast feeding was raised, two-thirds of the physicians advised the patient to continue antimalarials throughout breast feeding and about a quarter suggested continuing antimalarials, but bottle feeding the baby. Only 13% stopped antimalarials. It is known that very little hydroxychloroquine gets into breast milk.

What is the impact for people living with arthritis?

The results reported are consistent with studies following women with lupus who have become pregnant taking antimalarials such as hydroxychloroquine. Thus, the fact that a number of studies that have followed these women have not found any toxicity is reassuring. However, one would need a much larger number of cases to feel even reasonably certain that the benefits of hydroxychloroquine in preventing flare-ups outweighed the unknown risks. The fact that the majority of lupus experts feel the drug is safe and that they have not seen any toxicity is good news. Every year, these experts see about 200 women with lupus who are pregnant.

The Research Team

Principal Investigator

  • Adeeba Al Herz – MBBS, FRCPC, ABIM Rheumatology Fellow; Division of Rheumatology, University of British Columbia Arthritis Research Canada

Co-Investigators

  • Michael Schulzer MD, PhD Professor, Departments of Medicine and Statistics, University of British Columbia
  • John M. Esdaile MD MPH, FRCPC Scientific Director, ARC Professor and Head, Division of Rheumatology University of British Columbia

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