The Effects of Chloroquine on Serum 1,25-Dihydroxyvitamin D and Calcium Metabolism in Sarcoidosis

O’Leary, Timothy J.; Jones, Glenville; Yip, Agatha; Lohnes, D; Cohanim, M.; Yendt, Edmund R.

doi:10.1056/nejm198609183151203

Cited by 143 publications

(54 citation statements)

References 22 publications

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“…Patients with SLE often take hydroxychloroquine, which has been suspected to reduce the conversion of 25(OH)D3 to the more biologically active 1,25(OH)2D3 [27]. Lower 1,25(OH)2D3 levels was reported in patients with lupus treated with hydroxychloroquine, although circulating 25(OH)D3 levels did not differ.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus

et al. 2010

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Vitamin D is a pleiotrophic hormone with immunoregulatory properties. Low levels of vitamin D have been discovered in various autoimmune diseases. Here, we investigated serum vitamin D levels in Koreans with systemic lupus erythematosus (SLE) and examined whether levels correlate with disease activity of SLE. Blood samples were prospectively collected from patients with SLE (n = 104) and normal controls (NC, n = 49) during the spring from March to May 2008. The level of serum 25-hydroxyvitamin D (25(OH)D3) was measured by radioimmunoassay. The serum 25(OH)D3 levels of patients with SLE (42.49 ± 15.08 ng/ml) were significantly lower than NC (52.72 ± 15.19 ng/ml, P \ 0.001). Additionally, 17 patients with SLE (16.3%) had vitamin D insufficiency, while two NC had vitamin D insufficiency (4.1%). The risk of vitamin D insufficiency was 4.6-fold increased in SLE (P = 0.032). The serum 25(OH)D3 levels, adjusted with BMI, were positively correlated only with hemoglobin (b = 0.256, P = 0.018) and serum complement 3 (b = 0.365, P = 0.002). Serum vitamin D levels were lower, and vitamin D insufficiency was more common in Korean patients with SLE, however, our study demonstrated that vitamin D levels might not be a good marker of disease activity.

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Section: Discussionmentioning

confidence: 99%

Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus

et al. 2010

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“…In several case reports, serum calcium normalized within several weeks to months. (21)(22)(23) In one case, calcium and 1,25(OH) 2 D levels remained normal 18 months after discontinuation of chloroquine. (22) Limited data and the relatively high rate of spontaneous resolution of sarcoidosis make this observation difficult to interpret.…”

Section: Discussionmentioning

confidence: 94%

“…While the exact mechanism by which chloroquine reduces 1,25(OH) 2 D levels is unknown, it may impair granuloma formation. (22,23) Reichel and colleagues showed that chloroquine may induce 24-hydroxylase activity, thereby inactivating both 25(OH)D and 1,25(OH) 2 D. (13) The onset of action of chloroquine is slower than that of corticosteroids, but its effect may be more durable. In several case reports, serum calcium normalized within several weeks to months.…”

Section: Discussionmentioning

confidence: 99%

Hypercalcemia and soft tissue calcification owing to sarcoidosis: The sunlight-cola connection

Demetriou

Pietras

Holick

2010

Journal of Bone and Mineral Research

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Hypercalcemia occurs in sarcoidosis because of 1,25-dihydroxyvitamin D production by pulmonary alveolar macrophages. Longstanding hypercalcemia and hypercalciuria may cause such complications as nephrocalcinosis, nephrolithiasis, and soft tissue calcification, which can be at least partially reversible with treatment. Here we present a 43-year-old African-American man with diffuse soft tissue calcifications and acute kidney injury owing to sarcoidosis-induced hypercalcemia, probably exacerbated by sun exposure and phosphorus intake in the form of dietary cola drinks. Soft tissue calcifications resolved and kidney function improved significantly with hydration and glucocorticoid therapy. We discuss the pathophysiology of the hypercalcemia of sarcoidosis and current treatment options. ß

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“…553 Table 38 compares the toxicity of chloroquine to hydroxychloroquine. Table 39 summarizes the 11 reports of using an antimalarial agent for sarcoidosis [554][555][556][557][558][559][560][561][562][563] along with one series of use of these drugs for pulmonary fi brosis. 564 3.7.1.1 Toxicity-Chloroquine toxicity is most frequently encountered when parenteral routes are used to treat comatose patients with malaria.…”

Section: Information For Patientsmentioning

confidence: 99%

Monitoring of Nonsteroidal Immunosuppressive Drugs in Patients With Lung Disease and Lung Transplant Recipients

Baughman

Meyer

Nathanson

et al. 2012

Chest

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Objectives: Immunosuppressive pharmacologic agents prescribed to patients with diffuse interstitial and infl ammatory lung disease and lung transplant recipients are associated with potential risks for adverse reactions. Strategies for minimizing such risks include administering these drugs according to established, safe protocols; monitoring to detect manifestations of toxicity; and patient education. Hence, an evidence-based guideline for physicians can improve safety and optimize the likelihood of a successful outcome. To maximize the likelihood that these agents will be used safely, the American College of Chest Physicians established a committee to examine the clinical evidence for the administration and monitoring of immunosuppressive drugs (with the exception of corticosteroids) to identify associated toxicities associated with each drug and appropriate protocols for monitoring these agents. Methods: Committee members developed and refi ned a series of questions about toxicities of immunosuppressives and current approaches to administration and monitoring. A systematic review was carried out by the American College of Chest Physicians. Committee members were supplied with this information and created this evidence-based guideline. Conclusions: It is hoped that these guidelines will improve patient safety when immunosuppressive drugs are given to lung transplant recipients and to patients with diffuse interstitial lung disease. CHEST 2012; 142(5):e1S-e111SAbbreviations: ACCP 5 American College of Chest Physicians; ALT 5 alanine aminotransferase; ATG 5 antithymocyte globulin; CHF 5 congestive heart failure; CMV 5 cytomegalovirus; CNI 5 calcineurin inhibitor; COI 5 confl ict of interest; CsA 5 cyclosporin A; FDA 5 US Food and Drug Administration; HBV 5 hepatitis B virus; HMG-CoA 5 b -hydroxy-bmethylglutaryl-coenzyme A; HSP 5 Health and Science Policy Committee; IL2RA 5 IL-2 receptor a ; ILD 5 interstitial lung disease; IPF 5 idiopathic pulmonary fi brosis; ITP 5 idiopathic thrombocytopenia purpura; LAM 5 lymphangioleiomyomatosis; MESNA 5 sodium 2-sulfonylethanesufonate; MPA 5 mycophenolic acid; mTOR 5 mammalian target of rapamycin; PTLD 5 posttransplant lymphoproliferative disease; RCT 5 randomized controlled trial; SIRS 5 systemic infl ammatory response syndrome; TNF 5 tumor necrosis factor; TPMT 5 thiopurine methyltransferase

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The Effects of Chloroquine on Serum 1,25-Dihydroxyvitamin D and Calcium Metabolism in Sarcoidosis

Cited by 143 publications

References 22 publications

Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus

Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus

Hypercalcemia and soft tissue calcification owing to sarcoidosis: The sunlight-cola connection

Monitoring of Nonsteroidal Immunosuppressive Drugs in Patients With Lung Disease and Lung Transplant Recipients

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