HCQS significantly improves lipid profile in patients with rheumatoid arthritis and SLE: Study

rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) increase the risk of cardiovascular diseases and have an increased chance of morbidity and mortality. The inflammation of these diseases and the traditional risk factors like smoking, gender, hypertension, etc. increase the risk of cardiovascular disease (CVD) in these individuals. Previous research has shown that chloroquine or hydroxychloroquine (HCQ) can be used to treat CVD in these individuals. HCQs are preferred drugs for RA and SLE due to their lower toxicity. Literature has shown that HCQ has reduced flares and organ damage in SLE, improved lipid profiles in RA, and lowered pulse wave velocity (PWV) in SLE. However, there is ambiguity on the mechanism by which they reduce the CVD risk in individuals with RA and SLE. Hence researchers conducted a study to understand the potential beneficial effect of HCQ on cardiovascular risk factors in RA and SLE.

A non-blinded, interventional, randomized controlled trial was carried out in Sweden by including individuals with RA and SLE having low to moderate disease activity, aged 18–65, and fulfilling specific diagnostic criteria (SLICC for SLE, ACR/EULAR for RA). The participants were randomly divided into RA (n=25) or SLE (n=7) and were prescribed HCQ (Plaquenil®) 200 mg daily for 8 weeks. The primary endpoint was to evaluate the effect of HCQ treatment on traditional cardiovascular risk factors like blood lipids, glucose metabolism, blood pressure, and heart rate whereas the secondary endpoint was to know the effects of HCQ on PWV at baseline, after 4 weeks, and after 8 weeks of HCQ treatment.

Findings:

• There was a significant decrease in the levels of total cholesterol from 5.4 mmol/L to 5.1 mmol/L (p<0.001), low-density lipoproteins from 3,0 mmol/L to 2.7 mmol/L (p<0.001), and apolipoprotein B from 0.96 g/L to 0.90 g/L (p<0.01) After four weeks of treatment with HCQ.
• Even after eight weeks of treatment with HCQ, those levels remained unchanged.
• Levels of triglycerides, high-density lipoproteins, and apolipoprotein A1 remained unchanged during the study.
• HbA1c decreased in most patients, especially in patients with high levels at the start of HCQ, but increased HbA1c was seen in patients with low levels at the start of treatment with HCQ.
• No significant effect was seen on blood pressure or any measure of arterial stiffness.

Thus, the researchers concluded that HCQs led to small reductions in total cholesterol and LDL levels, a significant effect on HbA1c but the mechanism of cardiovascular risk reduction remained unclear. Considering the cardiovascular advantages of HCQ, future studies should focus on exploring its effects on inflammatory pathways, immunomodulatory properties and its influence on inflammatory mediators.

Further reading: Wahlin B, Braune A, Jönsson E, Wållberg-Jonsson S, Bengtsson C. Beneficial effects of hydroxychloroquine on blood lipids and glycated haemoglobin: A randomised interventional study in patients with rheumatoid arthritis and systemic lupus erythematosus. PLoS One. 2024;19(10):e0312546. Published 2024 Oct 28. doi:10.1371/journal.pone.0312546