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Cholesterol and chloroquine

LETTER TO THE EDITORS

Cholesterol and chloroquine

To the Editors of the Brazilian Journal of Rheumatology

The effect of antirheumatic drugs, including antimalarials, on the metabolism of lipoproteins is currently object of interest of researchers. The study by Rossoni et al.,1 published in the July-August 2011 issue of the Brazilian Journal of Rheumatology, has addressed this topic and evaluated the effect of chloroquine on the total cholesterol and HDL-cholesterol levels of patients with systemic lupus erythematosus (SLE). After adjusting for the use of statin and corticosteroids through multivariate analysis, those authors have reported that those serum levels are similar in patients using and not using antimalarials.

The complete evaluation of the lipid profile, regardless of the therapy used, should actually be a routine in the follow-up of those patients. It is worth knowing that lower serum levels of HDL-cholesterol are detected in SLE, and are inversely related to the inflammatory process.2 Indeed, the lipoprotein levels vary over the course of the disease, as has recently been demonstrated in the prospective study by the Toronto group,3 involving the cholesterol assessment of 1,260 SLE patients and a total of 26,267 measurements over 9.3 ± 8.5 years. The relevant conclusion of that study is that almost two thirds of those patients (64.7%) had an increase in total cholesterol over time, and that the variation of its levels was directly related to age, activity of disease, and use of corticosteroids and lipid lowering drugs. Another equally important result of that large longitudinal study was identifying that the use of antimalarials was negatively correlated with total cholesterol levels (P < 0.0001).3

In addition to that study, a recent review of the literature4 has identified seven other studies (cohort and prospective ones) that conclude that the antimalarial therapy for SLE determines a significant reduction in the serum lipid levels, including total cholesterol and LDL-cholesterol, when compared with other drugs. Three out of those seven studies have aimed at assessing the effect of antimalarials on SLE patients undergoing corticotherapy. They have also identified a reduction in LDL-cholesterol and total cholesterol levels, in addition to an increase in HDL-cholesterol levels, when compared with those of patients undergoing exclusive corticosteroid therapy.4 On the other hand, only two other studies (Chinese and Iranian) have not detected significant alterations in the lipid profile with the use of chloroquine in SLE,4 as reported in this study.3

The mechanism of the effect of antimalarials on the metabolism of lipoproteins has been the object of a previous study of our group.5 The in vivo evaluation of the LDL-cholesterol metabolism in SLE patients using or not chloroquine, as compared with healthy controls, was carried out by using a nanoemulsion of LDE (radioisotope-labeled LDL). This methodology enabled identifying that antimalarials actually interfere with the function of the LDL receptor, increasing the plasma removal of that lipoprotein, and leading to a reduction in its serum levels, and, consequently, in total cholesterol.5

In fact, further studies confirming that mechanism of action on the metabolism of lipoproteins are required to evidence one more beneficial effect of antimalarials on SLE.

Eduardo Ferreira Borba

Associate Professor of Rheumatology at the Medical School of the Universidade de São Paulo - USP

REFERENCES

  • 1
    Rossoni C, Bisi MC, Keiserman MW, Staub HL. Antimaláricos e perfil lipídico em pacientes com lúpus eritematoso sistêmico. Rev Bras Reumatol 2011;51(4):385-7.
  • 2
    Borba EF, Bonfá E. Dyslipoproteinemias in systemic lupus erythematosus: influence of disease, activity, and anticardiolipin antibodies. Lupus 1997;6(6):533-9.
  • 3
    Nikpour M, Gladman DD, Ibanez D, Harvey PJ, Urowitz MB. Variability over time and correlates of cholesterol and blood pressure in systemic lupus erythematosus: a longitudinal cohort study. Arthritis Res Ther 2010;12(3):R125.
  • 4
    Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, Khamashta MA. Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Ann Rheum Dis 2010;69(1):20-8.
  • 5
    Sachet JC, Borba EF, Bonfá E, Vinagre CG, Silva VM, Maranhão RC. Chloroquine increases low-density lipoprotein removal from plasma in systemic lupus patients. Lupus 2007;16(4):273-8.

Publication Dates

  • Publication in this collection
    22 Nov 2011
  • Date of issue
    Dec 2011
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