Second Antimalarial Agent May Be Effective in Cutaneous Lupus Despite Failure of Initial Agent

Subacute cutaneous lupus erythematosus
Subacute cutaneous lupus erythematosus
An observational study evaluated the effect of switching from one antimalarial agent to another agent in cutaneous lupus erythematosus after initial therapy was ineffective or not tolerated.

In patients with cutaneous lupus erythematosus (CLE) in whom treatment with one antimalarial (AM) agent has failed because of inefficacy or poor tolerability, switching to a second AM agent may prove to be beneficial in certain individuals, according to the results of a recent retrospective observational study published in the Journal of the American Academy of Dermatology.

The objective of the study was to evaluate cutaneous responses resulting from a change from hydroxychloroquine to chloroquine therapy, or the reverse, after failure of the original AM agent. The study was conducted between 1997 and September 2015. Patients’ overall cutaneous response rates and reasons for failure of the switch were assessed for up to 48 months.

A total of 64 patients with CLE were enrolled in the study. Overall, 78% of the participants were women. In 48 participants, the switch in AM agent was made because of initial AM inefficacy, and in 16 participants, the switch was made because of adverse events (AEs) associated with the initial AM agent. Median follow-up was 42 months (range, 3-171 months).

Among those patients who switched AM agents because of inefficacy, 56% (27 of 48) had a response to the new agent at month 3, with 18 individuals (37%) experiencing a partial response and 9 (19%) experiencing a complete response. The response decreased over time, however, with a median duration of administration of 9 months before failure of the second AM agent (95% CI, 6-24). Regarding sustained cutaneous response, 19 of 45 participants (42%) had a response at 12 months, 13 of 42 (31%) at 24 months, and 9 of 40 (22%) at 48 months.

In those patients who switched AM agents because of AEs, the second AM agent was well tolerated in 69% of participants. Moreover, participants who switched AM agents for AEs experienced AEs significantly more often than did those who changed AM agents for inefficacy (31% [5 of 16] vs 12% [6 of 48], respectively; P =.02).

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Of the 16 patients who switched AMs for AEs, 11 exhibited good tolerance of the second agent, with 9 of 11 (82%) having a response at 3 months.

The investigators concluded that switching AM agents may be advantageous for select patients with CLE. When an AM agent was switched because of AEs, more than two-thirds of patients demonstrated good tolerance to the second AM agent, with most exhibiting a sustained cutaneous response. Thus, a second AM agent should be tested before concluding that a patient is intolerant of all AM agents.


Chasset F, Arnaud L, Jachiet M, et al. Changing antimalarial agents after inefficacy or intolerance in patients with cutaneous lupus erythematosus: A multicenter observational study [published online October 20, 2017] J Am Acad Dermatol. doi: 10.1016/j.jaad.2017.08.045