Hydroxychloroquine found ineffective for patients with hand OA

WASHINGTON — Hydroxychloroquine ineffective for reducing symptoms and radiographic progression in patients with moderate to severe hand pain and osteoarthritis, according to data presented at the American College of Rheumatology Annual Meeting.

“For hydroxychloroquine, there is a lot of anecdotal evidence over the years, a lot of information suggesting it might help,” Philip G. Conaghan, PhD, at Leeds Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds in the United Kingdom, said in his presentation. “So, the question remains, ‘Does treating the inflammation of osteoarthritis reduce pain?’ Hydroxychloroquine was not a bad start.”

Conaghan and colleagues assessed 248 patients with radiographic hand osteoarthritis (OA), as well as symptomatic hand OA. Patients had a VAS pain score of at least 4 and were randomized to receive either hydroxychloroquine (HCQ) (n = 114) — with a dose ranging from 200 mg to 400 mg (mean dose = 320 mg) — or placebo for 12 months. After 6 months, the researchers assessed the average hand pain during the previous 2 weeks. At 12 months, they measured self-reported pain and function, grip strength, quality-of-life measures, radiographic structural change and baseline radiographic severity as secondary outcomes. They also assessed the effects of baseline radiographic severity for 143 patients who underwent ultrasound for small joints in one hand. Afterward, the researchers conducted an intention-to-treat analysis, as well as an economic analysis. Follow-up was 84.7% and 76.6% at 6 months and 12 months, respectively.

After 12 months, the difference on the numeric pain rating scale was –0.16 points between HCQ and placebo. There was no significant difference at 3 months, 6 months or 12 months for any secondary outcomes. Baseline structural damage did not have an effect.

On ultrasound, 94% had at least one joint positive for greyscale synovitis and 59% were power Doppler positive. In addition, synovitis did not impact treatment point differences. In the economic analysis, HCQ produced a smaller quality-adjusted life-year (QALY) gain than placebo, although it costed less, saving £6,545 per QALY lost.

Based on their results, the researchers do no recommend HCQ for this patient group. – by Will Offit

Reference:

Conaghan PG, et al. Abstract #3134. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.

Disclosure: The researchers report no relevant financial disclosures.