Costedoat-Chalumeau Nathalie, Dunogué Bertrand, Morel Nathalie, Le Guern Véronique, Guettrot-Imbert Gaëlle
AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France.
AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France.
Presse Med. 2014 Jun;43(6 Pt 2):e167-80. doi: 10.1016/j.lpm.2014.03.007. Epub 2014 May 19.
The efficacy of antimalarials, especially hydroxychloroquine (HCQ), in preventing systemic lupus erythematosus (SLE) flares is well demonstrated. However, many studies show that the percentage of SLE patients treated with HCQ remains low. By blocking the toll-like receptor 7 and 9 in plasmacytoid dendritic cells, HCQ inhibits interferon-alpha production which plays a crucial role in SLE pathogenesis. In addition to reducing damage accrual in SLE patients, HCQ appears to protect against the occurrence of diabetes, thrombotic events, and dyslipidemia. As a consequence, some studies have suggested that HCQ, which is inexpensive, has a protective effect on survival in SLE patients. Thanks to the pharmacokinetic properties of HCQ (long half-life) and to the availability of its blood assay, very low or undetectable blood HCQ concentrations are a valuable marker of non-adherence to treatment, thus adding a new benefit to HCQ prescriptions. The main side effect of HCQ is retinal toxicity. This complication is very rare, but may be potentially severe, thus requiring regular screening. Retinal toxicity remains the only absolute contra-indication of HCQ in adult SLE patients. Other contra-indications are few and rare. During pregnancy and breast-feeding, HCQ continuation is not only allowed but recommended. In conclusion, the risk/benefit ratio of HCQ is excellent. Many now believe that all SLE patients should be offered this treatment.
抗疟药，尤其是羟氯喹（HCQ），在预防系统性红斑狼疮（SLE）发作方面的疗效已得到充分证实。然而，许多研究表明，接受HCQ治疗的SLE患者比例仍然很低。通过阻断浆细胞样树突状细胞中的Toll样受体7和9，HCQ抑制了在SLE发病机制中起关键作用的α-干扰素的产生。除了减少SLE患者的损伤累积外，HCQ似乎还能预防糖尿病、血栓形成事件和血脂异常的发生。因此，一些研究表明，价格低廉的HCQ对SLE患者的生存具有保护作用。由于HCQ的药代动力学特性（半衰期长）及其血液检测的可用性，极低或无法检测到的血液HCQ浓度是治疗依从性差的一个有价值的指标，从而为HCQ处方增添了一项新的益处。HCQ的主要副作用是视网膜毒性。这种并发症非常罕见，但可能很严重，因此需要定期筛查。视网膜毒性仍然是成人SLE患者使用HCQ的唯一绝对禁忌症。其他禁忌症很少见。在怀孕和哺乳期，不仅允许继续使用HCQ，而且还建议使用。总之，HCQ的风险/效益比非常好。现在许多人认为，所有SLE患者都应该接受这种治疗。
