Effects of Anti-Malarial Drug, Hydroxychloroquine, on Glucose and Lipid Metabolism in Japanese Population

Abstract

Background: Hydroxychloroquine (HCQ) is a synthetic anti-malarial drug and has been used for the treatment of rheumatic diseases. Recently, HCQ has been reported to improve lipid and glucose metabolism in patients with rheumatic diseases. However, effects of HCQ on lipid and glucose metabolism in Japanese remain unknown. Methods: We picked up patients who had been prescribed HCQ for 1 month or longer between September 2015 and August 2018. We compared the data at baseline and at 1-11 months after the start of HCQ. We excluded patients who discontinued to take HCQ due to adverse reaction, and patients who had taken daily more than 20 mg of prednisolone with HCQ. Results: We found 40 patients, and excluded nine patients who discontinued to take HCQ due to adverse reactions and five patients who had taken daily more than 20 mg of prednisolone in addition to HCQ, and we analyzed 26 patients. Twenty-two systemic lupus erythematosus (SLE) patients and 4 rheumatoid arthritis (RA) patients had been prescribed HCQ. Hemoglobin A1c (HbA1c) showed a significant decrease and tendency to decrease at 5 and 6 months after the start of HCQ, respectively. At other time points, HbA1c showed non-significant decrease. Serum triglyceride showed a significant decrease at 1, 3, 7, 8 and 11 months after the start of HCQ. At other time points, serum triglyceride showed non-significant decrease. Serum high-density lipoprotein-cholesterol (HDL-C) did not show any significant changes at every time point. Serum low-density lipoproteincholesterol (LDL-C) showed a significant decrease at 2 months after the start of HCQ and showed tendency to decrease after 7 and 10 months. At other time points, serum LDL-C showed non-significant decrease. Serum non-HDL-C showed a significant decrease at 2, 3 and 7 months after the start of HCQ and showed tendency to decrease after 1 and 5 months. At other time points, serum non-HDL-C showed non-significant decrease. Conclusion: HCQ was associated with reduction of HbA1c, serum triglyceride, LDL-C and non-HDL-C levels in SLE and RA patients.

RETRACTED: Environmental impacts of COVID-19 treatment: Toxicological evaluation of azithromycin and hydroxychloroquine in adult zebrafish

“…Interestingly, HCQ generally has protective actions against dyslipidemia (high blood lipid levels). This can lead to a reduction in cardiovascular diseases, systemic lupus erythematosus and rheumatic diseases (Cairoli et al, 2012;Masui et al, 2019;Morris et al, 2011). However, the consequences of the synergistic negative effect of AZT and HCQ on triglyceride levels still need to be further studied.…”

Repurposing New Use for Old Drug Chloroquine against Metabolic Syndrome: A Review on Animal and Human Evidence

“…Lower HOMA-IR was also seen in rheumatoid arthritis patients receiving HCQ 46 . In Japanese population, it was also found that patients with SLE or rheumatoid arthritis (n=26; aged 46 ± 16 years) prescribed with HCQ with mean daily dose of 284.6 ± 67.5 mg had lower HbA1c after five and six months of HCQ 47 . On the contrary, distinct findings were obtained from a randomised, blinded crossover trial.…”

“…However, the most likely interaction between methotrexate and CQ is the reduction of methotrexate bioavailability when co-administered with CQ 63 . In a study recruiting SLE patients (n=22) and rheumatoid arthritis (n=4) patients prescribing HCQ for more than a month, the lipid profile of these patients improved significantly visualised by the lowering of TG, LDL-C and non-HDL-C 47 . In addition, significant decreases in TC, atherogenic index and increase in HDL-C were also noted in female patients with Sjögren's syndrome (n=71; aged 64 ± 11 years) receiving HCQ 64 .…”

Oral antidiabetic drugs and their interaction with disease-modifying drugs

“…En la búsqueda de interacciones entre ADO y DMARDs nos encontramos con un panorama diferente en el uso de hidroxicloroquina (HCQ) en artritis reumatoide, no necesariamente una (8) interacción . Se ha demostrado que casi el 50% de pacientes con artritis reumatoidea presentan (9) disminución de la sensibilidad a la insulina (SI) asociada a inflamación crónica . La hidroxicloroquina (HCQ) es un antimalárico, de buena tolerancia, se ha comprobado que además de su papel antiinflamatorio e inmunomodulador, la HCQ posee mecanismos directos sobre el metabolismo de la glucosa y de los lípidos, llevando a descenso en el colesterol total, los triglicéridos, elevación del HDL, que llevarían a los pacientes a un mejor control glucémico y a disminuir el riesgo de padecer diabetes (10) mellitus 2 .…”