Quinacrine in the Treatment of Cutaneous Lupus Erythematosus: Practical Aspects and a Case Series

González-Sixto, B.; García-Doval, I.; Oliveira, R.; Posada, C.; García-Cruz, M.A.; Cruces, M.

doi:10.1016/S1578-2190(10)70580-1

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Abstract

Hydroxychloroquine and chloroquine are antimalarials used as first-line treatment of cutaneous lupus. Quinacrine is not often employed by Spanish physicians due to a lack of information about its use and the fact that it is not marketed in Spain. It is effective in monotherapy or in combination therapy with other antimalarials. One of the advantages of quinacrine over chloroquine and hydroxychloroquine is that it does not appear to cause retinal toxicity.

Quinacrine is used as second-line therapy in patients with pre-existing eye problems that contraindicate treatment with chloroquine or hydroxychloroquine (after evaluation of which drug has the better risk-benefit relationship), and in combination therapy with other antimalarials in patients with resistance or only a partial response to chloroquine or hydroxychloroquine.

We report 8 cases of patients with cutaneous lupus who received treatment with quinacrine in monotherapy or in combination with other antimalarials. Lesions resolved in 5 patients and improved in 3. Therapy had to be withdrawn in 1 patient due to an exacerbation of his psoriasis.

Keywords:

Cutaneous lupus erythematosus

Antimalarials

Quinacrine

Adverse effect

Resumen

Los antimaláricos de primera elección en el tratamiento del lupus cutáneo son la hidroxicloroquina (hydroxychloroquine) y la cloroquina (chloroquine). La quinacrina (Qn) se emplea poco, fundamentalmente por la ausencia de información sobre su utilización y por no estar comercializada en España. Es eficaz en combinación con otros antimaláricos y en monoterapia. La quinacrine parece carecer de toxicidad retiniana y ésta es una de sus ventajas sobre la chloroquine y la hydroxychloroquine.

Se utiliza cuando existen alteraciones oculares previas al tratamiento que contraindican el uso de otros antimaláricos (al valorar la opción con mejor relación riesgo-beneficio), y en tratamiento combinado con otros antimaláricos en pacientes resistentes o parcialmente respondedores a chloroquine o hydroxychloroquine.

Presentamos una serie de 8 casos de pacientes con lupus cutáneo que han recibido tratamiento con quinacrine en monoterapia o combinada con otros antimaláricos, se obtuvo resolución de las lesiones en 5 pacientes y mejoría de éstas en 3 pacientes. En uno de los pacientes fue necesario suspender el tratamiento por la aparición de un brote de psoriasis.

Palabras clave:

Lupus eritematoso cutáneo

Antimaláricos

Quinacrina

Efecto secundario

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References

[1.]

F. Page.

Treatment of lupus erythematosus with mepacrine.

Lancet, 2 (1951), pp. 755-758

Medline