Quinacrine for Lupus

What is Lupus?

Lupus is a chronic autoimmune condition that can affect many parts of the body including the skin, kidneys, central nervous system and blood vessels. The body’s immune system cannot distinguish between foreign bacteria or viruses, such as the flu, from the body’s own healthy tissues. This condition causes inflammation, and damage to various organs of the body. With treatment, symptoms of lupus can be controlled and patients can live a healthier life.

Quinacrine

FDA-approved therapies for lupus currently include immunosuppressant drugs such as corticosteroids, hydroxychloroquine and belimumab (Benlysta). Hydroxychloroquine is the drug of choice for many physicians who treat rheumatologic skin diseases. Quinacrine, also called mepacrine, is a medication in the same drug class as hydroxychloroquine and is used in the treatment of lupus as well. Currently, quinacrine is not approved in the U.S. however, oral compounding of it is permitted to a limited extend for lupus. Quinacrine is an option to use alone or in combination with hydroxychloroquine to provide adequate treatment for patients.

Quinacrine provides an alternative to patient unable to tolerate hydroxychloroquine and its derivatives because of their structural differences. For example, a side effect of hydroxychloroquine is retinopathy at higher doses. Patient who already suffer from this or experience this due to the medication would benefit from quinacrine because it is not known to cause this effect. Most common side effects of quinacrine include nausea, stomach pain, and headache.

Other Uses

Quinacrine is also used as an anthelmintic to treat tapeworms, giardiasis and malaria. It can also be used as a sclerosing agent to prevent pneumothorax in patients with cystic fibrosis. For these indications, quinacrine/mepacrine is not the drug of choice however, provide a treatment option to select patients.

References:

Lupus Foundation of America. What is lupus? [Internet]. Washington (DC): Lupus Foundation of America. c2017. Available from: http://resources.lupus.org/entry/what-is-lupus
Rheumatologic Dermatology Society. Antimalarial medications [Internet]. Rheumatologic Dermatology Society. c2017. Available from: http://www.rheumaderm-society.org/antimalarial-medications/
Mishra S, Hull KM, Orleans RJ. Pharmacy Compounding Advisory Committee Meeting: Quinacrine hydrochloride [Internet]. U.S Food and Drug Administration. Mar 8, 2016. Available from: https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/PharmacyCompoundingAdvisoryCommittee/UCM490729.pdf