Aviña-Zubieta J A, Galindo-Rodriguez G, Newman S, Suarez-Almazor M E, Russell A S
Department of Medicine, University of Alberta, Canada.
Ann Rheum Dis. 1998 Oct;57(10):582-7. doi: 10.1136/ard.57.10.582.
The purpose of this study was to compare the long-term effectiveness between chloroquine (CQ) and hydroxychloroquine (HCQ).
Medical charts of all patients seen by eight rheumatologists practising in two tertiary care centres and starting antimalarial treatment between January 1985 and December 1993 were reviewed. Patient characteristics, disease, and treatment information were collected. The main outcome measures were the cause of and the time to the discontinuation of antimalarial drugs resulting from all causes, principally toxicity or inefficacy, or both. Bivariate analysis including t tests and chi 2 tests were used to assess differences between means and proportions respectively. Survival curves were evaluated using the Kaplan-Meier method. Multivariate analysis (Cox regression) was used to adjust for potential confounders.
After all medical records were reviewed, 1042 eligible cases were identified. From these, 940 (90%) had usable information and they represent the cohort. Five hundred and fifty eight had rheumatoid arthritis, 178 had systemic lupus erythematosus, 127 had palindromic arthritis, and 77 had other diagnoses. Fifty seven per cent of the patients received CQ and 43% HCQ. The proportion of patients with side effects taking HCQ and CQ was 15% and 28% respectively (p = 0.001). Using Cox regression model to adjust for age at the onset of antimalarial treatment, physician differences, sex, disease type, disease duration before treatment, and rank selection, there were no differences in the hazard ratio (HR) for overall discontinuations between CQ and HCQ. While the HR for discontinuations because of toxicity was lower for HCQ (HR = 0.6, 95% CI 0.4, 0.9), the HR for discontinuations because of inefficacy was significantly higher for HCQ (HR = 1.4, 95% CI 1.1, 1.9).
After adjusting for time and several confounders HCQ was less toxic but less effective than CQ. Only one case of probable/possible retinopathy was found. Therefore, we propose a careful baseline ophthalmological evaluation by an expert and then one or every two years if proper doses are used.
本研究旨在比较氯喹（CQ）和羟氯喹（HCQ）的长期疗效。
回顾了在两个三级医疗中心执业的八位风湿病学家在1985年1月至1993年12月期间诊治并开始抗疟治疗的所有患者的病历。收集了患者特征、疾病和治疗信息。主要结局指标是因各种原因（主要是毒性或无效或两者兼有）停用抗疟药物的原因和时间。分别使用包括t检验和卡方检验的双变量分析来评估均值和比例之间的差异。使用Kaplan-Meier方法评估生存曲线。使用多变量分析（Cox回归）来调整潜在的混杂因素。
在审查了所有病历后，确定了1042例符合条件的病例。其中，940例（90%）有可用信息，他们代表了该队列。558例患有类风湿性关节炎，178例患有系统性红斑狼疮，127例患有回纹型关节炎，77例有其他诊断。57%的患者接受了CQ，43%接受了HCQ。服用HCQ和CQ出现副作用的患者比例分别为15%和28%（p = 0.001）。使用Cox回归模型调整抗疟治疗开始时的年龄、医生差异、性别、疾病类型、治疗前疾病持续时间和等级选择后，CQ和HCQ在总体停药风险比（HR）上没有差异。虽然因毒性停药的HR对于HCQ较低（HR = 0.6，95% CI 0.4，0.9），但因无效停药的HR对于HCQ显著较高（HR = 1.4，95% CI 1.1，1.9）。
在调整时间和几个混杂因素后，HCQ的毒性较小，但疗效不如CQ。仅发现1例可能的视网膜病变。因此，我们建议由专家进行仔细的基线眼科评估，然后如果使用适当剂量，则每一年或两年进行一次评估。
