Seyed Mostafa Monzavi1, Aida Alirezaei2,3, Zhaleh Shariati-Sarabi4,5, Jalil Tavakol Afshari6, Mahmoud Mahmoudi6, Banafsheh Dormanesh7, Faezeh Jahandoost1,8, Ali Reza Khoshdel7, Ali Etemad Rezaie9. 1. Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2. Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. aidaalirezaee@gmail.com. 3. Department of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. aidaalirezaee@gmail.com. 4. Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. shariatij@mums.ac.ir. 5. Department of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. shariatij@mums.ac.ir. 6. Immunology Research Center, Buali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran. 7. AJA University of Medical Sciences, Tehran, Iran. 8. Department of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 9. Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
Abstract
BACKGROUND: Hydroxychloroquine (HCQ) is a widely prescribed medication to patients with systemic lupus erythematosus (SLE), with potential anti-inflammatory effects. This study was performed to investigate the efficacy of HCQ therapy by serial assessment of disease activity and serum levels of proinflammatory cytokines in SLE patients. METHODS: In this prospective cohort study, 41 newly diagnosed SLE patients receiving 400 mg HCQ per day were included. Patients requiring statins and immunosuppressive drugs except prednisolone at doses lower than 10 mg/day were excluded. Outcome measures were assessed before commencement of HCQ therapy (baseline visit) as well as in two follow-up visits (1 and 2 months after beginning the HCQ therapy). Serum samples of 41 age-matched healthy donors were used as controls. RESULTS: Median levels of IL-1β (p < 0.001), IL-6 (p = 0.001), and TNF-α (p < 0.001) were significantly higher, whereas, median CH50 level was significantly lower (p < 0.001) in SLE patients compared with controls. Two-month treatment with HCQ resulted in significant decrease in SLEDAI-2K (p < 0.001), anti-dsDNA (p < 0.001), IL-1β (p = 0.003), IL-6 (p < 0.001) and TNF-α (p < 0.001) and a significant increase in CH50 levels (p = 0.012). The reductions in SLEDAI-2K and serum levels of IL-1β and TNF-α were significantly greater in the first month compared with the reductions in the second month. CONCLUSION: HCQ therapy is effective on clinical improvement of SLE patients through interfering with inflammatory signaling pathways, reducing anti-DNA autoantibodies and normalizing the complement activity.
BACKGROUND:Hydroxychloroquine (HCQ) is a widely prescribed medication to patients with systemic lupus erythematosus (SLE), with potential anti-inflammatory effects. This study was performed to investigate the efficacy of HCQ therapy by serial assessment of disease activity and serum levels of proinflammatory cytokines in SLEpatients. METHODS: In this prospective cohort study, 41 newly diagnosed SLEpatients receiving 400 mg HCQ per day were included. Patients requiring statins and immunosuppressive drugs except prednisolone at doses lower than 10 mg/day were excluded. Outcome measures were assessed before commencement of HCQ therapy (baseline visit) as well as in two follow-up visits (1 and 2 months after beginning the HCQ therapy). Serum samples of 41 age-matched healthy donors were used as controls. RESULTS: Median levels of IL-1β (p < 0.001), IL-6 (p = 0.001), and TNF-α (p < 0.001) were significantly higher, whereas, median CH50 level was significantly lower (p < 0.001) in SLEpatients compared with controls. Two-month treatment with HCQ resulted in significant decrease in SLEDAI-2K (p < 0.001), anti-dsDNA (p < 0.001), IL-1β (p = 0.003), IL-6 (p < 0.001) and TNF-α (p < 0.001) and a significant increase in CH50 levels (p = 0.012). The reductions in SLEDAI-2K and serum levels of IL-1β and TNF-α were significantly greater in the first month compared with the reductions in the second month. CONCLUSION:HCQ therapy is effective on clinical improvement of SLEpatients through interfering with inflammatory signaling pathways, reducing anti-DNA autoantibodies and normalizing the complement activity.
Authors: Pooneh S Akhavan; Jiandong Su; Wendy Lou; Dafna D Gladman; Murray B Urowitz; Paul R Fortin Journal: J Rheumatol Date: 2013-04-15 Impact factor: 4.666
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