Hydroxychloroquine is turning Japanese – I really think so!

I had the greatest chat with Naoto Yokogawa today - representing the Japanese Hydroxychloroquine (HCQ) Study Group at their poster. This young man told me that until 2015, hydroxychloroquine was unavailable in Japan because of the banning of chloroquine in 1974 after multiple lawsuits related to retinal toxicity. Naoto told me that in the past, chloroquine was not properly dosed, leading to inappropriate and prolonged usage. For example – he stated that doses of 1000 mg were not unheard of. As a result, the drug was deemed unsafe and was eventually banned due to all the litigation.

So the Japanese Hydroxychloroquine Study Group conducted a double-blind, randomized, parallel-group study of hydroxychloroquine in 103 cutaneous lupus patients in Japan (72 in the HCQ group, 24 in the placebo group). Fortunately, the study demonstrated good efficacy of the drug for cutaneous lupus, as well as extra-cutaneous manifestations including pain, fatigue, and MSK. While there were reports of drug eruption, hepatic dysfunction and cellulitis (weird – probably not related?), there were no reports of retinopathy (phew).

Beyond the fact that Japanese lupus patients have clearly not reaped the benefits of antimalarials for all these years, this study is also significant because it is the first clinical trial to evaluate the effects of hydroxychloroquine on cutaneous lupus. I can attest to seeing many lupus patients who have flared in terms of their skin (or other organ systems) after discontinuing hydroxychloroquine. Many of us are often urging our lupus patients to stay on their antimalarial.

This study is important because it gives actual data as to why antimalarials are beneficial and confirms their overall good safety profile. Furthermore, it helps support the reality that monitored, properly dosed antimalarials can be safely used in the lupus population. So hydroxychloroquine is "turning Japanese" - I really think so! (just like the title song by The Vapors says!)

More reports from ACR 2015