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Treating Lupus with Antimalarial Drugs

Treating Lupus with Antimalarial Drugs

Lupus is a disorder that causes the immune system to target the body’s own tissues and organs leading to inflammation. Several drugs that initially were used to prevent or treat malaria are now also used for treating lupus including quinacrine, chloroquine, and hydroxychlorquine. These drugs treat lupus symptoms by mildly suppressing the immune system, which reduces inflammation throughout the body.

What is Lupus?

While the exact cause of lupus is not known, it is likely due to a combination of genetic and environmental factors. It may be related to an inability to clear damaged cells from the body, which causes excessive stimulation of the immune system. The disease is more common in women than men and affects particular ethnic groups like African Americans and Asians more than others.

The symptoms of lupus can be associated with other diseases so a diagnosis may be difficult to determine at first. Symptoms can include a butterfly-shaped rash on the cheeks and other rashes over the body, pain and swelling in joints, inflammation of the lungs or heart that causes chest pain, neurological problems, and kidney problems.

A clear determination of whether symptoms are being caused by lupus can be made with the use of an antinuclear antibodies (ANA) test. In most lupus patients, ANAs will be present in a blood test and a lack of them is a clear indication that symptoms are not being caused by lupus.

Antimalarials and Lupus

Antimalarials have immunosuppressive effects that make them an effective treatment for lupus symptoms like skin rashes, mouth ulcers, and arthritis. An antimalarial treats lupus by decreasing the production of autoantibodies, which leads to decreased inflammation in the heart, lungs, joints, and skin. For long-term maintenance of lupus symptoms, antimalarial drugs like quinacrine, chloroquine, and hydroxychloroquine are almost always prescribed.

These drugs for treating lupus are what are known as disease-modifying drugs, which means they do not cure lupus but manage the disease’s symptoms. Many lupus patients will take an antimalarial medication for their entire lives to manage their symptoms. Long-term use of these drugs is safe in most cases. There are three commonly used antimalarials for treating lupus:

Hydroxychloroquine is the most frequently prescribed antimalarial for treating lupus. Many rheumatologists find that it has fewer side effects than other antimalarials. It is sold under the brand name Plaquenil in the United States.

Chloroquine may have more side effects but is prescribed if a patient can not take hydroxychloroquine. Chloroquine and hydroxychloroquine are both on the World Health Organization’s list of essential medicines.

Quinacrine was first used as an antimalarial drug during the 1930s and especially during WWII for soldiers who were sent to places like North Africa. Similar antimalarials had been used since the 1890s to treat lupus. Quinacrine stopped being marketing in 1995 and is no longer available commercially. Now quinacrine can only be obtained from a compounding pharmacy. Although this particular antimalarial is not currently FDA-approved, it has a long history of use and is effective at treating lupus.

Triquin

For many years these three drugs were combined together into a drug that was known as Triquin. This treatment combination was approved to treat lupus in 1958 but was withdrawn in 1973 for lack of evidence that the combination was effective. However recent evidence reaffirms that the combination can be an effective treatment for lupus and formulations with all three drugs can be obtained from a compounding pharmacy.

What Antimalarials Can Do for Lupus Symptoms

Antimalarials can improve many symptoms of lupus through their ability to slow down the immune system without increasing the odds for infection. Some of the ways that antimalarials like hydroxychloroquine, chloroquine, and quinacrine can treat lupus include:

  • Reduce and prevent skin rashes
  • Reduce joint pain and muscle aches
  • Reduce fatigue
  • Reduce mouth sores
  • Protect against inflammation of the heart, lungs, and other organs
  • Protect against UV radiation from the sun
  • Reduce cholesterol
  • Prevent kidney damage

More Prescribing Information

  • While some benefits may be noticed sooner, most antimalarial drugs can take up to three months for the full effects to be noticeable. These drugs do not provide immediate results but work gradually over time.
  • Smoking should be completely avoided when taking antimalarial drugs for lupus. Individuals with lupus have a higher risk of cardiovascular disease, which is an important reason to quit on its own. However smoking also decreases the effectiveness of antimalarial drugs.
  • It is usually recommended that antimalarial drugs for treating lupus be taken with food to avoid nausea.

Common Antimalarial Prescriptions for Treating Lupus

  • Quinacrine 100mg Capsules
  • Chloroquine 100mg Capsules
  • Chloroquine 250mg Capsules
  • Chloroquine 500mg Capsules
  • Hydroxychloroquine 200mg Capsules
  • Hydroxychloroquine 300mg Capsules
  • Hydroxychloroquine 400mg Capsules
  • Quinacrine 100mg, Chloroquine 250mg Capsules
  • Quinacrine 100mg, Chloroquine 250mg, Hydroxychloroquine 200mg Capsules

Other Drugs That Treat Lupus

Nonsteroidal anti-inflammatory drugs (NSAIDS) decrease inflammation and swelling. There are OTC versions of these drugs available such as ibuprofen, which are taken orally. A compounding pharmacy can also make topical NSAIDS in the form of a cream or gel that can be applied directly to the affected joints. For some patients there is a benefit to having the medication applied topically instead of taking it orally. A cream can avoid metabolism by the liver and reduce potential side effects, especially for patients who are already on multiple medications.

Corticosteroids reduce inflammation, pain, and swelling that result from lupus. Cortisone is naturally produced in the body to reduce inflammation and synthetic versions can help when the immune system is not functioning normally. These medications slow down the inflammatory response from lupus and reduce the activity of the immune system. Steroids are sometimes used in high doses for cases of lupus that are especially severe and where the heart or lungs are affected.

Belimumab was recently approved by the FDA for treating mild cases of lupus. It works by inhibiting B cells that cause the immune system to overreact. The results of clinical trials for this drug have been both positive and negative; with most agreeing that it has only a modest effect. It is also the most expensive lupus drug available with a one-year supply costing about $35,000 per year for an individual.

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