Impact of antimalarial (AM) on serum lipids in systemic lupus erythematosus (SLE) patients: A systematic review and meta-analysis

BACKGROUND: Dyslipidemia is a common disorder in systemic lupus erythematosus (SLE) patients. It is still inconclusive whether antimalarial drugs could affect the serum lipids in SLE patients, therefore we conducted a systematic review and meta-analysis of available data to address this issue. METHODS: We comprehensively searched the databases of PubMed, EMBASE and Cochrane Library from date of inception to Sep 2018 for both randomized controlled trials (RCTs) and observational studies. Review Manager 5.3 software was used for analysis. We performed meta-analysis using random-effects model and weighted the mean difference (WMD) and its 95% confidence interval (CI). The Q test was used to assess the presence of heterogeneity and the I(2) index was used to quantify the extent of heterogeneity. RESULTS: In total, 8 studies met our selection criteria including 2 RCTs, 2 cohort studies, and 4 case-control studies. There were 717 patients (336 patients in CQ (chloroquine) or HCQ (hydroxychloroquine) group, and 381 patients in control group (SLE patients without the therapy of AM)). Compared with the control group, TC, TG, LDL-C, VLDL-C were associated with a significant decrease, respectively (WMD = −21.40 mg/dL, 95% CI −27.62 to −15.18, P < .00001), (WMD = −29.07 mg/dL, 95% CI −45.28 to −12.86, P = .0004), (WMD = −16.25 mg/dL, 95% CI −28.82 to −3.68, P = .01), (WMD = −6.41 mg/dL, 95% CI −12.39 to 0.44, P = .04), however the change of HDL-C did not reach statistically significance (WMD = 4.42 mg/dL, 95% CI −1.21 to 10.06, P = .12). CONCLUSIONS: CQ or HCQ can infect the serum lipids in SLE patients. However, these results should be interpreted with cautions since lacking sufficient RCTs.