Mohammadpour Fatemeh, Kargar Mona, Hadjibabaie Molouk
Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.
J Res Pharm Pract. 2018 Jan-Mar;7(1):4-12. doi: 10.4103/jrpp.JRPP_17_60.
Immune Thrombocytopenia (ITP) is an autoimmune disease in which platelet destruction causes thrombocytopenia. Due to the known steroid toxicities, alternative agents have been evaluated for the treatment of these patients. We aimed to review the literature and find evidences regarding the potential benefits of hydroxychloroquine (HCQ) as a steroid-sparing agent in the treatment of ITP. We searched English language articles within Web of Science, PubMed, and Scopus. Cohorts, clinical trials, case reports, conference papers, and letters were included. We excluded papers which either focused on administration of HCQ for non-ITP conditions or studies on other treatment modalities for ITP. In total, 54 ITP cases with either primary or systemic lupus erythematosus (SLE)-associated ITP were included in four studies (SLE-associated ITP; = 23). All patients have received corticosteroids previously and >90% received other agents with HCQ concomitantly. Overall response was achieved in more than 60% of patients. Sustained response in 18 (33.3%) patients was associated with no treatment or HCQ alone. One of the studies reported a significantly better response in patients with definite SLE compared to those with positive antinuclear antibody and no definite SLE. Similarly, another study found a nonsignificant trend toward better long-term response in patients with definite SLE compared to incomplete SLE. The included articles reported the efficacy of the HCQ with acceptable safety. Available data regarding the use of HCQ for this indication are spare and more studies are needed in ITP with different severity. It seems that HCQ can be considered as an option in the treatment of SLE-associated ITP, and although promising, currently, the place of HCQ in the treatment of ITP continues to evolve.
免疫性血小板减少症（ITP）是一种自身免疫性疾病，其中血小板破坏导致血小板减少。由于已知类固醇的毒性，人们已对替代药物进行评估以治疗这些患者。我们旨在回顾文献并找到有关羟氯喹（HCQ）作为治疗ITP的类固醇节约剂的潜在益处的证据。我们在科学网、PubMed和Scopus中搜索了英文文章。纳入了队列研究、临床试验、病例报告、会议论文和信函。我们排除了那些专注于HCQ用于非ITP病症给药的论文或关于ITP其他治疗方式的研究。四项研究共纳入了54例原发性或系统性红斑狼疮（SLE）相关ITP病例（SLE相关ITP；n = 23）。所有患者此前均接受过皮质类固醇治疗，超过90%的患者同时接受了其他药物和HCQ治疗。超过60%的患者实现了总体缓解。18例（33.3%）患者的持续缓解与未治疗或仅使用HCQ有关。其中一项研究报告称，与抗核抗体阳性且无明确SLE的患者相比，明确SLE患者的反应明显更好。同样，另一项研究发现，与不完全SLE患者相比，明确SLE患者有更好的长期反应的趋势但无统计学意义。纳入的文章报告了HCQ的疗效及可接受的安全性。关于HCQ用于该适应症的现有数据较少，不同严重程度的ITP还需要更多研究。似乎HCQ可被视为治疗SLE相关ITP的一种选择，尽管前景广阔，但目前，HCQ在ITP治疗中的地位仍在不断演变。
