Hydroxychloroquine during pregnancy and breastfeeding
Keywords:
HYDROXYCHLOROQUINE, SYSTEMIC LUPUS ERYTHEMATOSUS, PREGNANCY, BREAST FEEDINGAbstract
Treating patients with systemic autoinmune diseases during pregnancy and breastfeeding may be complex and results in a challenge for professionals responsible for them.
There is evidence about the benefits of hydroxychloroquine (HCQ) with an adequate margin of safety in patients with this condition.
This update aims to describe effectiveness and safety of HCQ in the treatment of systemic autoinmune diseases during pregnancy and breastfeeding.
It has been proved that the use of HCQ during pregnancy reduces systemic lupus erythematosus (SLE) activity, the risk of a lupus flare up, as well as the requirements of glucocorticoids during pregnancy and breastfeeding.
Discontinuing antimalarial treatment during pregnancy is deleterious for both the mother and the fetus.
No tetratogenic effects or retinal harm have been found to be caused by HCQ in the children of mothers exposed to this treatment during such period.
In conclusion, the treatment with HCQ during pregnancy and breastfeeding is effective and has adequate safety margins. Thus, it must continue to be used during this period.
References
(2) Laporte J, Tognoni G. Estudios de utilización de medicamentos y de farmacovigilancia. In: Laporte J, Tognoni G. Principios de epidemiología del medicamento. 2ª ed. Barcelona: Masson-Salvat, 1993. p.1-23.
(3) Conde JL. Eficacia y efectividad: una distinción útil para la práctica y la investigación clínicas. Nefrología 2002; (22)3: 219-22.
(4) Costedoat-Chalumeau N, Dunogué B, Morel N, Le Guern V, Guettrot-Imbert G. Hydroxychloroquine: a multifaceted treatment in lupus. Presse Med. 2014; 43:e167-e80.
(5) Olsen NJ, Schleich MA, Karp DR. Multifaceted effects of hydroxychloroquine in human disease. Semin Arthritis Rheum. 2013; 43: 264-72.
(6) Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, Khamashta MA. Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Ann Rheum Dis. 2010; 69: 20.
(7) Felson DT, Anderson JJ, Meenan RF. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Results of two metaanalyses. Arthritis Rheum. 1990; 33: 1449-61.
(8) Stelton CR, Connors DB, Walia SS, Walia HS. Hydrochloroquine retinopathy: characteristic presentation with review of screening. Clin Rheumatol. 2013; 32: 895-8.
(9) Sammaritano L, Bermas B. Rheumatoid arthritis medications and lactation. Curr Opin Rheumatol. 2014, 26: 354-60.
(10) Clowse ME, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum. 2005; 52: 514-21.
(11) Clowse ME, Magder L, Witter F, Petri M. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum. 2006; 54: 3640-7.
(12) Levy RA, Vilela VS, Cataldo MJ, Ramos RC, Duarte JL, Tura BR, et al. Hydroxychloroquine (HCQ) in lupus pregnancy: double-blind and placebo-controlled study. Lupus 2001; 10: 401-4.
(13) Costedoat-Chalumeau N, Amoura Z, Duhaut P, Huong DL, Sebbough D, Wechsler B, et al. Safety of hydroxychloroquine in pregnant patients with connective tissue diseases: a study of one hundred thirty-three cases compared with a control group. Arthritis Rheum. 2003; 48: 3207-11.
(14) Klinger G, Morad Y, Westall CA, Laskin C, Spitzer KA, Koren G, et al. Ocular
toxicity and antenatal exposure to chloroquine or hydroxychloroquine for
rheumatic diseases. Lancet 2001; 358: 813-4.
(15) Osadchy A1, Ratnapalan T, Koren G. Ocular toxicity in children exposed in utero to antimalarial drugs: review of the literature. J Rheumatol. 2011; 38: 2504-8.
(16) Buyon JP, Rupel A, Clancy RM. Neonatal lupus syndromes. Lupus 2004; 13:705-12.
(17) Izmirly PM, Costedoat-Chalumeau N, Pisoni CN, Khamashta MA, Kim MY, Saxena A, et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation 2012; 126: 76-82.
