Antimalarials for treating rheumatoid arthritis

  • Review
  • Intervention




Antimalarials have been used for the treatment of rheumatoid arthritis (RA) for several decades. Recently several trials have been published with larger sample sizes, and better design than previous studies. These newer trials have evaluated the efficacy and toxicity of hydroxychloroquine.


To assess the short-term efficacy and toxicity of antimalarials for the treatment of rheumatoid arthritis (RA).

Search methods

We searched the Cochrane Musculoskeletal Group's trials register, the Cochrane Controlled Trials Register, MEDLINE and EMBASE up to and including August 2000. We also carried out a handsearch of the reference lists of the trials retrieved from the electronic search.

Selection criteria

All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing antimalarials against placebo in patients with RA

Data collection and analysis

Data abstraction was carried out independently by two reviewers. The same two reviewers using a validated checklist (Jadad 1996) assessed the methodological quality of the RCTs and CCTs. Rheumatoid arthritis outcome measures were extracted from the publications for the 6-month endpoint. The pooled analysis was performed using standardized mean differences for joint counts, pain and global assessments. Weighted mean differences were used for erythrocyte sedimentation rate (ESR). Toxicity was evaluated with pooled odds ratios for withdrawals. A chi-square test was used to assess heterogeneity among trials. Fixed effects models were used throughout.

Main results

We found four trials, with 300 patients randomized to hydrochloroquine and 292 to placebo. Only trials evaluating hydroxychloroquine could be pooled in the analysis. A statistically significant benefit was observed when hydroxychloroquine was compared to placebo. The standardized mean differences for the various outcome measures ranged from -0.33 to -0.52, and were statistically significant. Statistically significant differences were also observed for ESR. Overall withdrawals and withdrawals due to lack of efficacy were significantly more frequent in the placebo group. No differences were observed in withdrawals due to toxicity.

Authors' conclusions

Hydroxychloroquine appears to be efficacious for the treatment of RA. Its overall effect appears to be moderate, but its low toxicity profile should be considered when treating patients with RA.








搜尋包括Cochrane Musculoskeletal trials register, Cochrane Controlled Trials Register, EMBASE 及 EDLINE (直到2000年8月),同時手動搜尋所選文章之參考文獻。




兩位作者獨立進行資料摘錄。每篇試驗研究的品質由兩位作者獨立使用驗證過的品質評估工具﹝Jadad分數﹞進行評估。類風濕性關節炎病人之測量為試驗6個月時的結果。使用標準化平均差異分析關節數目、疼痛、及整體評估。使用加權平均差異分析紅血球沉降速率。副作用分析則計算病患退出停止使用的勝算比﹝OR﹞。本文使用卡方檢定各試驗間異質性,並用固定效應模型(fixedeffects model)分析。


4個研究包含於分析中,300例病患使用抗瘧疾藥物,292例病患使用安慰劑。抗瘧疾藥物比安慰劑療效上有統計上顯著差異。不同結果的標準化平均差異介於 −0.33 to −0.52 之間。紅血球沉降速率也有統計上顯著差異。整體退出及因無效而退出者,在安慰劑組較多。因副作用而退出在兩組並無差異。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Antimalarials for treating rheumatoid arthritis

Antimalarials have been used for the treatment of rheumatoid arthritis (RA) for several decades. This review found four trials, with 300 patients receiving hydrochloroquine and 292 receiving placebo. A benefit was observed in the patients taking hydroxychloroquine compared to placebo. There was no difference between the two groups in terms of those who had to withdraw from trials due to side effects.

Hydroxychloroquine appears to be helpful for the treatment of RA.