The cholesterol lowering effect of antimalarial drugs is enhanced in patients with lupus taking corticosteroid drugs

J Rheumatol. 1999 Feb;26(2):325-30.

Abstract

Objective: To examine the relationship between antimalarial therapy and total cholesterol in patients with systemic lupus erythematosus (SLE) with or without steroid therapy.

Methods: Retrospective study for the University of Toronto Lupus Clinic database between 1976 and 1997. The effects of antimalarials on random total cholesterol levels were assessed in the following situations: patients not receiving steroids (part I) that either initiated or discontinued antimalarials; patients receiving steroids (part II) that were either on a stable dose or initiating antimalarials; and patients initiating steroids with or without antimalarials (part III). Paired t test, Fisher's exact test, and 2 way analysis of variance were used when appropriate.

Results: Initiation of antimalarials reduced the baseline total cholesterol by 4.1 % at 3 months in 53 patients (p = 0.020) and by 0.6% at 6 months in 30 patients (p = NS), while the cessation of antimalarials increased the total cholesterol by 3.6% at 3 months in 38 patients (p = NS) and 5.4% at 6 months in 22 patients (p = NS). In 181 patients taking steroids and antimalarials, the mean total cholesterol was 11% less than for 201 patients receiving a comparable dose of steroids alone (p = 0.0023). Initiation of antimalarials on a stable dose of steroids reduced the total cholesterol by 11.3% at 3 months in 29 patients (p = 0.0002) and 9.4% at 6 months in 20 patients (p = 0.004). For patients initiating steroids, the percentage increase in cholesterol was lower in those taking antimalarials compared to patients without antimalarial therapy (p = 0.0149).

Conclusion: Antimalarials lower total cholesterol in patients receiving steroids and may minimize steroid induced hypercholesterolemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antimalarials / pharmacology*
  • Antimalarials / therapeutic use
  • Antirheumatic Agents / pharmacology
  • Antirheumatic Agents / therapeutic use
  • Chloroquine / pharmacology
  • Chloroquine / therapeutic use
  • Cholesterol / blood*
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Glucocorticoids / pharmacology*
  • Glucocorticoids / therapeutic use
  • Humans
  • Hydroxychloroquine / pharmacology
  • Hydroxychloroquine / therapeutic use
  • Hypercholesterolemia / drug therapy
  • Hypercholesterolemia / prevention & control
  • Lupus Erythematosus, Systemic / drug therapy
  • Lupus Erythematosus, Systemic / metabolism*
  • Prednisone / pharmacology*
  • Prednisone / therapeutic use
  • Retrospective Studies

Substances

  • Antimalarials
  • Antirheumatic Agents
  • Glucocorticoids
  • Hydroxychloroquine
  • Chloroquine
  • Cholesterol
  • Prednisone