An Update on the Use of Hydroxychloroquine in Cutaneous Lupus Erythematosus: A Systematic Review

J Am Acad Dermatol. 2020 Mar;82(3):709-722. doi: 10.1016/j.jaad.2019.07.027. Epub 2019 Jul 13.

Abstract

Background: Hydroxychloroquine is widely used for the treatment of cutaneous lupus erythematosus (CLE). Although new recommendations exist for hydroxychloroquine dosing, there is still uncertainty about the dosage that will elicit a satisfactory response in CLE while limiting adverse effects, specifically retinopathy.

Objective: To summarize hydroxychloroquine dosages, outcomes, and adverse effects in the treatment of CLE, focusing on retinopathy.

Methods: A comprehensive literature search from inception to December 2018 was performed in Ovid MEDLINE, Ovid Embase, and The Cochrane Library (Wiley). Studies were screened against predefined inclusion and exclusion criteria.

Results: Twelve studies were selected and included 5 retrospective studies, 3 prospective studies, 2 case series, and 2 randomized controlled trials. These studies show that a hydroxychloroquine dosage up to 400 mg/d is effective for most CLE patients (range of effectiveness, 50%-97%), with few adverse effects. One incidence of retinopathy, after a very high cumulative dose, was reported across all 12 studies (852 total patients).

Limitations: Because retinopathy and other serious adverse effects may not appear until much later, many of these studies are limited by short follow-up time.

Conclusions: This evidence suggests that hydroxychloroquine for CLE is effective at 400 mg/d, with an exceedingly low incidence of retinopathy and other adverse effects.

Keywords: adverse effects; cutaneous lupus erythematosus; hydroxychloroquine; recommendations; retinopathy; screening; systematic review.

Publication types

  • Review