Details

Autor(en) / Beteiligte

• Chasset, F.
• Bouaziz, J.‐D.
• Costedoat‐Chalumeau, N.
• Francès, C.
• Arnaud, L.

Titel

Efficacy and comparison of antimalarials in cutaneous lupus erythematosus subtypes: a systematic review and meta‐analysis

Ist Teil von

• British journal of dermatology (1951), 2017-07, Vol.177 (1), p.188-196

Ort / Verlag

England: Oxford University Press

Erscheinungsjahr

2017

Quelle

Wiley-Blackwell Journals

Beschreibungen/Notizen

• Summary Background The antimalarials (AMs) hydroxychloroquine (HCQ) and chloroquine (CQ) have demonstrated variable cutaneous response rates in cutaneous lupus erythematosus (CLE). Objectives We sought to assess the global cutaneous response rates to HCQ and CQ, with respect to CLE subtypes, based on previously published studies. Methods We performed a systematic review and meta‐analysis of studies published in MEDLINE, Embase and the Cochrane Library between 1965 and December 2015. The proportions of responders to AMs according to CLE subtypes were extracted from individual studies and pooled using random‐effects or fixed models. The odds ratio (OR) was used as the measure of association to compare the response rates between CLE subtypes and AMs. Results Among 1990 courses of treatment with AMs from 31 included studies, the overall response rate to AMs was 63% [95% confidence interval (CI) 55–70], with important statistical heterogeneity across the included studies. HCQ had a higher overall efficacy than CQ, but this was not significant (OR 1·48, 95% CI 0·98–2·23). The response rate to AMs was different between CLE subtypes, ranging from 31% (95% CI 20–44) for chilblain lupus to 91% (95% CI 87–93) for acute CLE. The response was significantly higher for acute CLE than for subacute CLE and intermittent CLE. In case of failure of monotherapy with AM, the combination of quinacrine with HCQ or CQ seemed effective, whereas too little data were available to assess the efficacy of the switch to another AM agent. Conclusions Wide discrepancies in cutaneous response to AMs are observed between CLE subtypes. A specific therapeutic approach considering CLE subtypes may improve CLE management. What's already known about this topic? The antimalarials (AMs) hydroxychloroquine (HCQ) and chloroquine (CQ) are usually recommended as the first‐line systemic treatment of cutaneous lupus erythematosus (CLE). AMs have demonstrated variable cutaneous response rates in CLE. Cutaneous response rates to HCQ and CQ, particularly between CLE subtypes, remain largely unknown. What does this study add? In this meta‐analysis, the pooled cutaneous response rate to AMs was 63%, 95% confidence interval (CI) 55–70. The response rate to AMs differed between CLE subtypes, ranging from 31% (95% CI 20–44) for chilblain lupus to 91% (95% CI 87–93) for acute CLE. The response to AMs was significantly higher for acute CLE than for subacute CLE and intermittent CLE. Linked Comment: McCourt. Br J Dermatol 2017; 177:14–15 Plain language summary available online