Esdaile J M
Division of Rheumatology, Montreal General Hospital, McGill University, Canada.
Lupus. 1993 Feb;2 Suppl 1:S3-8.
The use of antimalarial drugs to treat systemic lupus erythematosus (SLE) is reviewed regarding their value in SLE of mild-to-moderate disease activity, as corticosteroid-sparing agents, and as an adjunctive therapy in severe SLE. A retrospective controlled study of a variety of antimalarials and a randomized discontinuation trial of hydroxychloroquine support the considerable clinical belief that antimalarials are of benefit in mild-to-moderate SLE. Anecdotal reports and the opinion of experienced clinicians suggest that antimalarials permit the use of lower doses of corticosteroids. No controlled study has confirmed a corticosteroid-sparing role for antimalarials, although no controlled study has been conducted specifically to address this hypothesis. The data on antimalarials in severe SLE are scant. Antimalarials are likely effective in at least a subgroup of SLE patients with mild-to-moderate disease activity. Whether these agents are corticosteroid sparing and prevent severe disease exacerbations is unproven. Given the low toxicity of antimalarials, further studies are clearly warranted.
本文综述了抗疟药在治疗系统性红斑狼疮（SLE）中的应用，包括其在轻至中度疾病活动度的SLE中的价值、作为糖皮质激素节约剂的作用以及在重度SLE中的辅助治疗作用。一项关于多种抗疟药的回顾性对照研究和一项羟氯喹的随机撤药试验支持了临床普遍认为抗疟药对轻至中度SLE有益的观点。轶事报道和经验丰富的临床医生的意见表明，抗疟药可使糖皮质激素的用量降低。尽管尚未专门进行对照研究来验证这一假设，但尚无对照研究证实抗疟药具有糖皮质激素节约作用。关于抗疟药在重度SLE中的数据很少。抗疟药可能至少对一部分轻至中度疾病活动度的SLE患者有效。这些药物是否能节约糖皮质激素并预防严重疾病加重尚未得到证实。鉴于抗疟药的低毒性，显然有必要进行进一步研究。
