Chloroquine as a steroid sparing agent for asthma

 

Abstract

Background

For the majority of chronic asthmatics, symptoms are best controlled using inhaled steroids, but for a small group of asthma sufferers, symptoms cannot be controlled using inhaled steroids and instead continuous use of high dosage oral steroids (corticosteroids) are required. However, using high dosage oral steroids for long periods is associated with severe side effects. Steroid-sparing treatments have been sought and one of these is chloroquine. Chloroquine is an anti-inflammatory agent, also used in the treatment of malarial infection and as a second-line therapy in the treatment of rheumatoid arthritis, sarcoidosis and systemic lupus erythematosus. All these diseases are associated with immunologic abnormalities hence the speculation that chloroquine might be used to control severe, poorly controlled bronchial asthma. There is a need to systematically evaluate the evidence regarding its use to reduce or eliminate oral corticosteroid use in asthma.

Objectives

The object of this review was to assess the efficacy of adding chloroquine to oral corticosteroids in patients with chronic asthma who are dependent on oral corticosteroids with the intention of minimising or eventually eliminating the use of these oral steroids.

Search methods

Searches of the Cochrane Airways Group Specialised Register were undertaken with predefined search terms. Searches are current as of February 2011.

Selection criteria

Only studies with a randomised placebo-controlled design met the inclusion criteria for the review.

Data collection and analysis

Two reviewers independently assessed studies for suitable in the review. Data were extracted and entered into RevMan 5.

Main results

One small study was included in the review. No significant findings were reported. An update search conducted in February 2007 did not identify any new studies.

Authors' conclusions

There is insufficient evidence to support the use of chloroquine as an oral steroid-sparing agent in chronic asthma. Further trials should optimise oral steroid dosage before addition of the steroid-sparing agent.

 

Plain language summary

Chloroquine as a steroid sparing agent for asthma

Asthma can be treated with drugs which aim to reduce inflammation in the airways. Inhaled corticosteroids are frequently used, but occasionally individuals require oral steroids for adequate control. However, oral steroids are frequently associated with severe side-effects. Chloroquine has been suggested as a useful 'add-on' therapy to oral steroid treatment with the aim of reducing the dose requirement in such asthma. This review found one small cross-over study but this did not provide adequate evidence to decide whether chloroquine should be offered to reduce or eliminate oral steroid treatment. There is a need for well-designed trials addressing this question before recommendations can be made.

 

摘要

背景

以chloroquine作為氣喘之類固醇減量劑

大多數慢性氣喘病人，症狀以吸入式類固醇得到最好的控制，但一小時氣喘患者症狀無法以吸入式類固醇獲得控制而代之以需要連續使用高劑量之口服類固醇(皮質類固醇)。然而，長期使用高劑量口服類固醇會伴隨嚴重的副作用。類固醇減量治療已被尋找，其中一種是chloroquine。Chloroquine是一種抗發炎藥物，它備用於治療瘧疾，並作為治療類風濕性關節炎、類肉芽腫瘤、全身性紅斑性狼之第二治療。所有這些疾病均伴隨免疫異常，因而顯示chloroquine可用作控制嚴重、控制不良之支氣管性氣喘。有需要作系統性評估有關此要減低或刪除口服皮質類固醇治療氣喘之證據。

目標

本回顧的目的是要評估慢性氣喘且依賴口服皮質類固醇的病人在口服皮質類固醇加上chloroquine在減低或最終消除使用口服類固醇之效益。

搜尋策略

以預設搜尋詞彙搜尋CAGSR，搜尋至2007年2月

選擇標準

以隨機安慰劑控制設計之研究作為回顧之納入標準。

資料收集與分析

兩位回顧者獨立地評估合於回顧之研究。數據摘出及鍵入RevMan 4.2.7。

主要結論

本回顧僅包含一項小規模的研究，其中並無顯著的發現。在2007年2月的一項更新搜尋並未鑑定出新的研究。

作者結論

沒有足夠證據支持慢性氣喘使用chloroquine作為口服類固醇減量劑。未來試驗應在加入類固醇減量劑前先將口服類固醇劑量作最適當之調整。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

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

總結

沒有足夠證據決定抗發炎藥物chloroquine能否對慢性氣喘作為有效的類固醇減量劑。氣喘可以用旨在降低氣道發炎之藥物為治療。吸入式類固醇常被採用，但偶有病人需要口服類固醇才能有足夠的控制。然而，口服類固醇常伴隨嚴重副作用。Chloroquine曾被建議是一種口服類固醇之附加治療，其目的為減少這類病人的類固醇用量。本回顧發現一項小規模的交叉研究，但沒有提供足夠證據決定chloroquine是否應用作減低或排除類固醇治療。在能對此問題提出建議之前必須有設計優良的試驗。