A Global Survey of Quinacrine Use in Systemic and Cutaneous Lupus Erythematosus.

Abstract

Experiences with the antimalarial quinacrine for systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE) remain underexplored. We evaluated and compared dermatologists' and rheumatologists' experiences with quinacrine in managing SLE and/or CLE. We sent a structured survey to 102 SLE specialists within the Systemic Lupus International Collaborating Clinics (SLICC) and the Canadian Network for Improved Outcomes in Systemic Lupus Erythematosus (CaNIOS), and 200 members of the Rheumatologic Dermatology Society (RDS). Participants responded to questions on self-reported quinacrine prescription history, perceived clinical benefit, reasons for drug discontinuation, and barriers to prescribing. A total of 20 dermatologists from RDS and 40 SLICC and CaNIOS members responded to the survey. All RDS participants (100%) had previously prescribed quinacrine, compared to 17/40 (43%) of SLICC/CaNIOS participants. The majority of quinacrine prescribers (100% RDS, 12/17 [71%] SLICC/CaNIOS) had prescribed quinacrine in combination with another antimalarial. Hydroxychloroquine (HCQ) or chloroquine (CQ) intolerance (65% RDS, 47% SLICC/CaNIOS) and HCQ/CQ-related retinal toxicity (50% RDS, 24% SLICC/CaNIOS) were other reasons for prescribing quinacrine. Clinical benefit was reported by 19/20 (95%) of RDS and 12/17 (71%) of SLICC/CaNIOS clinicians, and discontinuations were less frequent among RDS (5/20 [25%] reported none) compared to SLICC/CaNIOS (all 17 reported ≥ 1). Availability and cost of quinacrine were primary prescribing barriers. Surveyed dermatologists and rheumatologists differed in their experience with quinacrine for CLE and SLE, respectively. Availability remains a key barrier to prescribing, underscoring the need to address supply issues and conduct further research to optimize quinacrine use in SLE and CLE.