Usefulness of Hydroxychloroquine and Chloroquine in the Prevention of Malaria in Systemic Lupus Erythematosus: Experience from the University of Nigeria Teaching Hospital Enugu, Nigeria

Abstract

A bstract Background: The widespread report of chloroquine (CQ)-resistant malaria led to the development and use of a more efficacious artemisinin-based combination therapy. Use of CQ/hydroxychloroquine (HCQ) as effective therapy for malaria thus gradually decreased over the years, yet malaria continues to cause morbidity and mortality in malaria-endemic areas. The need to reevaluate CQ and HCQ (currently recommended for the management of systemic lupus erythematosus [SLE]) and ascertain possible significant prophylactic antimalarial usefulness spurred this study. Objective: This study aimed at establishing if there is any antimalarial prophylactic usefulness of HCQ/CQ among SLE patients. Materials and Methods: This was case–crossover retrospective cohort study. Convenience sampling and recruitment of known SLE patients of the tertiary healthcare institution on HCQ or CQ were performed. Malaria diagnosis among the participants before and 6 months after CQ/HCQ initiation was based on self-reporting of symptoms and confirmed by blood film microscopy for malaria parasitemia. Results: A total of 125 known SLE participants were recruited and assessed. The median age of participants was 37.0 years (IQR = 50.0–29.0). The median frequency of malaria before and 6 months after HCQ/CQ initiation were 4.84 per 6-month period (IQR = 5.0–4.0) and 1.00 per 6-month period (IQR = 1.01–1.00), respectively. The ranked mean of frequencies of malaria before HCQ/CQ was higher than that 6 months after HCQ/CQ commencement ( P = 0.00). Conclusion: HCQ and CQ appear to offer significant prophylaxis against malaria among Nigerian SLE patients