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June 22, 2020

Is Hydroxychloroquine Safe for Autoimmune Diseases?

COVID-19 has put a therapy called hydroxychloroquine in the spotlight — and, at the same time, shrouded it in confusion. Despite early hope from government officials and scientists that it would help fight the pandemic, the most recent reports suggest hydroxychloroquine is not necessarily effective in treating the new coronavirus and may have harmful consequences for some people.

But what does this mean for people who take hydroxychloroquine for other conditions — including autoimmune diseases like lupus and rheumatoid arthritis (RA)?

“The short answer is: Hydroxychloroquine is both safe and effective for treating many autoimmune diseases, and people who have been prescribed the drug should feel very comfortable continuing with it,” says Jane Buckner, MD, rheumatologist and president of Benaroya Research Institute at Virginia Mason (BRI). “It has a long history of helping patients — and we’re also exploring new ways to use it.”

What is hydroxychloroquine used for?

Hydroxychloroquine was developed 60 years ago to treat malaria, and doctors soon found that it also helps treat multiple autoimmune diseases. Rather than suppressing the whole immune system, the drug appears to work by stopping immune proteins called autoantibodies from triggering the immune response that causes these diseases.

“When the immune system gets activated in people with autoimmune disease, it becomes like a steamroller, attacking the body more and more aggressively,” Dr. Buckner says. “Our hope is to stop it early, before it picks up too much speed. And we believe hydroxychloroquine can do that.”

What are side effects of hydroxychloroquine?

The side effects of taking hydroxychloroquine are limited for most patients, including those with autoimmune disease.

“In appropriate doses, hydroxychloroquine is so safe that the FDA has even approved it for children and pregnant women,” Dr. Buckner says.

Early on, patients may experience mild nausea. Long-term use of the drug can damage the retina and impair vision.

“But patients get regular eye exams, so we can catch and respond to these issues early,” Dr. Buckner explains. “I have patients who have taken hydroxychloroquine for 20 years with no problems.”

Hydroxychloroquine’s side effects in COVID-19 patients

Adverse outcomes from the drug tend to result from taking it in large doses or for a long period of time, or from hydroxychloroquine’s interactions with other medications. This helps explain why some patients with COVID-19 have developed heart arrhythmias (unusual heart rhythms) and other issues in response to the drug.

Some patients were given large doses — much larger than what is prescribed for patients with lupus and other conditions. And COVID-19 patients are often in very poor health by the time they’re treated, with heart complications and other issues that people with autoimmune disease generally don’t have.

Exploring New Uses for Hydroxychloroquine

In addition to halting the progression of autoimmune diseases, BRI is also testing hydroxychloroquine and other therapies to see if they can prevent these diseases from emerging in the first place. This includes a new study of type 1 diabetes (T1D), conducted through BRI’s Diabetes Clinical Research Program and Type 1 Diabetes TrialNet.

T1D occurs when autoantibodies attack cells in the pancreas and, as a result, stop the body from properly regulating blood sugar. This happens over time: First, the body makes the autoantibodies (which scientists call stage 1 T1D). Later on — it can take weeks, months or years — they attack the pancreas (stage 3 T1D) and the patient has to take insulin injections to regulate their blood sugar.

“With our T1D trial, we’re testing whether hydroxychloroquine can stop this disease at stage 1 — when the risk is high, but before it’s causing harm,” Dr. Buckner says.

People in the study will take hydroxychloroquine and see doctors for check-ups every few months to see whether their disease progresses. Similar studies are now also underway for RA and lupus.

“This is the first time anyone has tested whether hydroxychloroquine can prevent T1D, and the RA trial is the first prevention study for that disease ever in the U.S.,” Dr. Buckner says. “I’m very excited to see what happens. Although hydroxychloroquine may not help fight COVID-19, it could very well lead to a breakthrough in the fight against autoimmune disease.”

Read more about living with autoimmune disease during the pandemic: Find common questions answered by our physician-researchers and try these tips to relieve stress and build resilience.

Below, watch rheumatologist and BRI President Jane Buckner, MD, answer questions about Type 1 Diabetes TrialNet's Hydroxychloroquine (HCQ) Prevention Study during a JDRF Facebook Live on March 27, 2020.

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