POSTER PRESENTATION Open Access The role of antimalarials in lupus nephritis: a review Senq-J Lee 1* , Earl D Silverman 1 , Joanne M Bargman 2 From 2011 Pediatric Rheumatology Symposium sponsored by the American College of Rheumatology Miami, FL, USA. 2-5 June 2011 Purpose Systemic lupus erythematosus (SLE) is a chronic multi- system autoimmune disease affecting various organs, with lupus nephritis being one of the most important and common serious manifestations. Antimalarials (AM) are one of the many immunomodifying medications 1 The Hospital for Sick Children, Toronto, ON, Canada Full list of author information is available at the end of the article Figure 1 Overview of effects of antimalarials on lupus disease and activity – articles from 2005 to 2010. LN=lupus nephritis. Lee et al. Pediatric Rheumatology 2012, 10(Suppl 1):A29 http://www.ped-rheum.com/content/10/S1/A29 © 2012 Lee et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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POSTER PRESENTATION Open Access
The role of antimalarials in lupus nephritis: areviewSenq-J Lee1*, Earl D Silverman1, Joanne M Bargman2
From 2011 Pediatric Rheumatology Symposium sponsored by the American College of RheumatologyMiami, FL, USA. 2-5 June 2011
PurposeSystemic lupus erythematosus (SLE) is a chronic multi-system autoimmune disease affecting various organs,
with lupus nephritis being one of the most importantand common serious manifestations. Antimalarials (AM)are one of the many immunomodifying medications
1The Hospital for Sick Children, Toronto, ON, CanadaFull list of author information is available at the end of the article
Figure 1 Overview of effects of antimalarials on lupus disease and activity – articles from 2005 to 2010. LN=lupus nephritis.
Lee et al. Pediatric Rheumatology 2012, 10(Suppl 1):A29http://www.ped-rheum.com/content/10/S1/A29
© 2012 Lee et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.
Figure 2 Overview of effects of antimalarials on cardiovascular disease and thrombosis – articles from 2005-2010. CVD = cardiovascular disease.aPL = antiphospholipid antibodies. TE = thromboembolic events. RA = rheumatoid arthritis.
Figure 3 Overview of studies on AMs and outcomes related to LN. MMF = mycophenolate mofetil.
Lee et al. Pediatric Rheumatology 2012, 10(Suppl 1):A29http://www.ped-rheum.com/content/10/S1/A29
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used in SLE, however less known is its role in lupusnephritis. Our study examined the history of AM use,theorized mechanisms of action, efficacy in SLE, in par-ticular in lupus nephritis, safety in pregnancy, and over-all safety profile.
MethodsWe conducted a search of all relevant literature usingMedline (OVID and EMBASE) and PubMed. We
included randomized-controlled trials, observationalcohort studies, and case-control studies. Case reportswere only included for the adverse effect profile ofAM.
Results•AM use benefits patients with SLE including improv-
ing survival, reducing disease activity, new organ invol-vement, integument damage, risk of infection, risk of
Figure 4 Overview of AM potential toxicity/adverse events
Lee et al. Pediatric Rheumatology 2012, 10(Suppl 1):A29http://www.ped-rheum.com/content/10/S1/A29
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thrombosis, and possible cardioprotective and anti-malignancy effects.•In lupus nephritis, AM use improves time to end-
stage renal disease, disease activity, flare rates, diseaseremission as an adjunct with other immunomodifyingdrugs, and reduced cumulative corticosteroid use.•AM are safe to use and should be continued in pregnant
SLE patients for its beneficial effects of reducing diseaseactivity, flare rates, cumulative corticosteroid requirements,and possible reduction in development of cardiac neonatallupus erythematosus.•AM have a good safety profile, withgastrointestinal symptoms being the most common. Care-ful regular monitoring for retinopathy is recommended asper American Academy of Ophthalmology.•In patients with renal disease, caution with dosing and
careful monitoring for adverse events should be taken.
ConclusionAM are medications which confer many benefits topatients with SLE and lupus nephritis, with a goodsafety profile.
DisclosureSenq-J. Lee: None; Earl D. Silverman: None; Joanne M.Bargman: None.
Author details1The Hospital for Sick Children, Toronto, ON, Canada. 2Toronto GeneralHospital, Toronto, ON, Canada.
Published: 13 July 2012
doi:10.1186/1546-0096-10-S1-A29Cite this article as: Lee et al.: The role of antimalarials in lupus nephritis:a review. Pediatric Rheumatology 2012 10(Suppl 1):A29.
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Lee et al. Pediatric Rheumatology 2012, 10(Suppl 1):A29http://www.ped-rheum.com/content/10/S1/A29
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