The use of hydroxychloroquine (HCQ) in patients with systemic lupus erythematosus (SLE) is associated with reductions in serum low-density lipoprotein cholesterol (LDL-C) levels. Results of a literature search conducted by an international team of researchers was published in the International Journal of Rheumatic Diseases.

Random-effects pooled mean difference with corresponding 95% CIs were estimated. Heterogeneity was calculated using I² values. Publication bias was evaluated with visual inspection of funnel plots.  Sensitivity analysis investigated whether the effect of HCQ on serum total cholesterol (TC) levels was similar to that of the main analysis.  The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence for each outcome. The quality of evidence (high, moderate, low, and very low) was rated via use of the GRADE system.

Pooled study participants included 559 patients from 8 observation studies (2 before-after studies and 6 case-control studies), which examined the effects of HCQ on serum LDL-C levels. Mean patient age was 45.7 years; 95.3% of the participants were women, and 58.4% were prednisone users.

The results of the study demonstrated that HCQ use significantly reduced mean LDL-C levels by 24.4 mg/dL (95% CI, 8.9-39.8; P =.002). Heterogeneity was extensive and significant (I² = 94.7%; P <.001). Additionally, HCQ use significantly reduced mean TC levels by 26.9 mg/dL (95% CI, 8.4-45.3; P =.004). No evidence of publication bias was identified based on visual assessment of funnel plots.

According to the investigators, the current meta-analysis is the first of its kind to quantitatively measure the favorable effects of HCQ treatment on serum LDL-C levels in patients with SLE.  “The clinical implications of HCQ leading to lipid lowering effects should be highlighted in preventative health care for this specific population.,” they added.

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Reference

Babary H, Liu X, Ayatollahi Y, et al. Favorable effects of hydroxychloroquine on serum low density lipid in patients with systemic lupus erythematosus: a systematic review and meta-analysis [published online September 8, 2017]. Int J Rheum Dis. doi: 10.1111/1756-185X.13159