Efficacy of antimalarial agents to prevent the progression of discoid lupus erythematosus to systemic lupus erythematosus: A retrospective cross-sectional study

Thanaporn Puaratanaarunkon,¹ Stephen J Kerr,² Pawinee Rerknimitr¹

¹ Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University
² Center for Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University

Abstract

Background: Discoid Lupus Erythematosus (DLE) patients have the potential to developing Systemic Lupus Erythematosus (SLE) at a later time. The prescription of antimalarial agents might be beneficial to prevent this progression but the validated data is still lacking.
Objectives: Our study aimed to explore whether antimalarial agent could slow progression to SLE in DLE patients, adjusting for other potential confounders.
Methods: We retrospectively studied 65 patients who were diagnosed as DLE and attended the outpatient clinic at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between January 1, 2017 and December 31, 2020. We reviewed medical records including history of DLE, SLE signs and symptoms, laboratory findings and treatment options.
Results: Over a total of 458.73 person years (PY), 19 patients (29.23%) eventually progressed to SLE within approximately 1 year. Of these, 15 patients had widespread lesions whereas only 4 patients presented with localized form. The prescription of antimalarial drug was associated with delayed SLE progression in our cohort. Other parameters such as generalized form (IRR 6.243 (95% CI 1.450–26.872); P = 0.014), joint involvement (IRR 5.005 (95% CI 1.931–12.969); P = 0.001) and LE specific skin lesions (IRR 3.799 (95% CI 1.220–11.825); P = 0.021) were considered as strong risk factors in SLE development.
Conclusions: Our study suggested that an antimalarial drug could postpone the SLE development in DLE patients.
Key words: Discoid lupus erythematosus, Systemic lupus erythematosus, Hydroxychloroquine, Chloroquine, Antimalarial drug, Disease progression