, Volume 26, Issue 5, pp 1175–1182 | Cite as

Efficacy analysis of hydroxychloroquine therapy in systemic lupus erythematosus: a study on disease activity and immunological biomarkers

  • Seyed Mostafa Monzavi
  • Aida AlirezaeiEmail author
  • Zhaleh Shariati-SarabiEmail author
  • Jalil Tavakol Afshari
  • Mahmoud Mahmoudi
  • Banafsheh Dormanesh
  • Faezeh Jahandoost
  • Ali Reza Khoshdel
  • Ali Etemad Rezaie
Original Article



Hydroxychloroquine (HCQ) is a widely prescribed medication to patients with systemic lupus erythematosus (SLE), with potential anti-inflammatory effects. This study was performed to investigate the efficacy of HCQ therapy by serial assessment of disease activity and serum levels of proinflammatory cytokines in SLE patients.


In this prospective cohort study, 41 newly diagnosed SLE patients receiving 400 mg HCQ per day were included. Patients requiring statins and immunosuppressive drugs except prednisolone at doses lower than 10 mg/day were excluded. Outcome measures were assessed before commencement of HCQ therapy (baseline visit) as well as in two follow-up visits (1 and 2 months after beginning the HCQ therapy). Serum samples of 41 age-matched healthy donors were used as controls.


Median levels of IL-1β (p < 0.001), IL-6 (p = 0.001), and TNF-α (p < 0.001) were significantly higher, whereas, median CH50 level was significantly lower (p < 0.001) in SLE patients compared with controls. Two-month treatment with HCQ resulted in significant decrease in SLEDAI-2K (p < 0.001), anti-dsDNA (p < 0.001), IL-1β (p = 0.003), IL-6 (p < 0.001) and TNF-α (p < 0.001) and a significant increase in CH50 levels (p = 0.012). The reductions in SLEDAI-2K and serum levels of IL-1β and TNF-α were significantly greater in the first month compared with the reductions in the second month.


HCQ therapy is effective on clinical improvement of SLE patients through interfering with inflammatory signaling pathways, reducing anti-DNA autoantibodies and normalizing the complement activity.


Complement system proteins Cytokines Hydroxychloroquine Systemic lupus erythematosus Treatment outcome 



The authors would like to thank vice chancellor for research of Mashhad University of Medical Sciences who kindly supported this study. The authors would also like to acknowledge Dr. K. Hashemzadeh and the staff of the department of internal medicine, Imam Reza Hospital, for their kind assistance during this study.

Compliance with ethical standards

Conflict of interest

All authors declared that they have no conflict of interest.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Seyed Mostafa Monzavi
    • 1
  • Aida Alirezaei
    • 1
    • 2
    Email author
  • Zhaleh Shariati-Sarabi
    • 1
    • 2
    Email author return OK on get
  • Jalil Tavakol Afshari
    • 3
  • Mahmoud Mahmoudi
    • 3
  • Banafsheh Dormanesh
    • 4
  • Faezeh Jahandoost
    • 1
    • 2
  • Ali Reza Khoshdel
    • 4
  • Ali Etemad Rezaie
    • 5
  1. 1.Rheumatic Diseases Research CenterMashhad University of Medical SciencesMashhadIran
  2. 2.Department of Internal Medicine, Imam Reza HospitalMashhad University of Medical SciencesMashhadIran
  3. 3.Immunology Research Center, Buali Research InstituteMashhad University of Medical SciencesMashhadIran
  4. 4.AJA University of Medical SciencesTehranIran
  5. 5.Rosalind Franklin University of Medicine and ScienceNorth ChicagoUSA

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