A Global Survey of Quinacrine Use in Systemic and Cutaneous Lupus Erythematosus

Sarah Aly; Gilda Parastandehchehr; Sasha Bernatsky; Évelyne Vinet; Laurent Arnaud; Nathalie Costedoat-Chalumeau; Paul R Fortin; John A Reynolds; Carter Thorne; Zahi Touma; Daniel Wallace; Victoria P Werth; Wendy Singer; Arielle Mendel

doi:10.3899/jrheum.2025-0757

A Global Survey of Quinacrine Use in Systemic and Cutaneous Lupus Erythematosus

J Rheumatol. 2025 Dec 1:jrheum.2025-0757. doi: 10.3899/jrheum.2025-0757. Online ahead of print.

Authors

Affiliations

¹ S. Aly, BHSc, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
² G. Parastandehchehr, MD, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
³ S. Bernatsky, MD, PhD, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Lupus and Vasculitis clinic, Division of Rheumatology, Department of Medicine, McGill University Health Centre, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
⁴ É. Vinet, MD, PhD, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Lupus and Vasculitis clinic, Division of Rheumatology, Department of Medicine, McGill University Health Centre, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
⁵ L. Arnaud, MD, PhD, Department of Rheumatology, National Reference Center for Autoimmune Diseases (RESO), INSERM UMS-1109, Strasbourg Academic Hospitals, Strasbourg, France.
⁶ N. Costedoat-Chalumeau, MD, PhD, Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP); Université de Paris Cité, Paris, France.
⁷ P.R. Fortin, MD, MPH, Division of Rheumatology, Department of Medicine, and Axe Maladies Infectieuses et Immunitaires du Centre de Recherche du CHU de Québec-Université Laval, and Centre ARThrite-UL, Quebec City, QC, Canada.
⁸ J.A. Reynolds, MD, PhD, Department of Inflammation and Ageing, School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, Rheumatology Department, Birmingham, UK.
⁹ C. Thorne, MD, Centre of Arthritis Excellence, Newmarket, ON, Canada; University of Toronto, Toronto, ON, Canada.
¹⁰ Z. Touma, MD, PhD, Division of Rheumatology, Toronto Lupus Program, University Health Network; University of Toronto, Toronto, ON, Canada.
¹¹ D. Wallace, MD, Cedars-Sinai Medical Center; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
¹² V.P. Werth, MD, Department of Dermatology, University of Pennsylvania Perelman School of Medicine and Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.
¹³ W. Singer, Singer Family Fund for Lupus Research, Montreal, QC, Canada.
¹⁴ A. Mendel, MD, MSc, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Lupus and Vasculitis clinic, Division of Rheumatology, Department of Medicine, McGill University Health Centre, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.

PMID: 41326167
DOI: 10.3899/jrheum.2025-0757

Abstract

Objective: Experiences with the antimalarial quinacrine for systemic and cutaneous lupus erythematosus (SLE and CLE) remain under-explored. We evaluated and compared dermatologists' and rheumatologists' experiences with quinacrine in managing SLE and/or CLE.

Methods: We sent a structured survey to 102 lupus specialists within the Systemic Lupus International Collaborating Clinics (SLICC) and the Canadian Network for Improved Outcomes in Systemic Lupus Erythematosus (CaNIOS), and 200 members of the Rheumatologic Dermatology Society (RDS). Participants responded to questions on self-reported quinacrine prescription history, perceived clinical benefit, reasons for drug discontinuation, and barriers to prescribing.

Results: A total of 20 dermatologists from RDS and 40 SLICC and CaNIOS members responded to the survey. All RDS participants (100%) had previously prescribed quinacrine, compared to 17/40 (43%) of SLICC/CaNIOS participants. The majority of quinacrine prescribers (100% RDS, 12/17 [71%] SLICC/CaNIOS) had prescribed quinacrine in combination with another antimalarial. Hydroxychloroquine or chloroquine intolerance (65% RDS, 47% SLICC/CaNIOS) and retinal toxicity (50% RDS, 24% SLICC/CaNIOS) were other reasons for prescribing quinacrine. Clinical benefit was reported by 19/20 (95%) of RDS and 12/17 (71%) of SLICC/CaNIOS clinicians, and discontinuations were less frequent among RDS (5/20 [25%] reported none) compared to SLICC/CaNIOS (all 17 reported ≥ 1). Availability and cost of quinacrine were primary prescribing barriers.

Conclusion: Surveyed dermatologists and rheumatologists differed in their experience with quinacrine for CLE and SLE, respectively. Availability remains a key barrier to prescribing, underscoring the need to address supply issues and conduct further research to optimize quinacrine use in SLE and CLE.