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Referencias

Referencias de los estudios incluidos en esta revisión

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Roberts 1988 {published data only}

Roberts JA, Gunneberg A, Elliott JA, Thomson NC. Hydroxychloroquine in steroid dependent asthma. Pulmonary Pharmacology 1988;1:59‐61.

Referencias de los estudios excluidos de esta revisión

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Charous 1990 {published data only}

Charous BL. Open study of hydroxychloroquine in the treatment of severe symptomatic or corticosteroid‐dependent asthma. Annals of Allergy 1990;65:53‐8.

Charous 1991 {published data only}

Charous BL. Effectiveness of long‐term treatment of severe asthma with hydroxychloroquine (HCQ). Annals of NY Academy of Sciences 1991;629:432‐3.

Hiragi 1964 {published data only}

Hiragi. Novel treatment for bronchial asthma. Sego Rynsko 1964;13(1):152‐7.

Isomaki 1968 {published data only}

Isomaki H, Kreus KE. Chloroquine in the treatment of bronchial asthma. Annals of Allergy 1968;26:61‐5.

Spector 1997 {published data only}

Spector SL. Alternative treatments in the patient with intractable asthma. Pulmonary Medicine 1997;3:23‐9.

Stern 1960 {published data only}

Stern A, Zucker A, Sherman W, Florio A. An investigation into the use of aralen in bronchial asthma. Annals of Allergy 1960;18:980‐2.

Tennenbaum 1966 {published data only}

Tennenbaum JI, Smith RE. Antimalarial therapy for resistant asthma. Annals of Allergy 1966;24:37‐40.

Referencias adicionales

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Adams 2008

Adams NP, Bestall JC, Lasserson TJ, Jones P, Cates CJ. Fluticasone versus placebo for chronic asthma in adults and children. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD003135.pub4]

Charous 1998

Charous BL, Halpern EF, Stevens GC. Hydroxychloroquine improves airflow and lowers circulating IgE levels in subjects with moderate symptomatic asthma. Journal of Allergy & Clnical Immunology 1998;102:198‐203.

Evans 2000

Evans DJ, Cullinan P, Geddes DM, Walters EH, Jones PW. Gold as an oral steroid sparing agent for asthma. Cochrane Database of Systematic Reviews 2000, Issue 4. [DOI: 10.1002/14651858.CD002985]

Goldstein 1983

Goldstein JA. Hydroxychloroquine for asthma (letter). American Review of Respiratory Disease 1983;128:1100‐1.

Jadad 1996

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Controlled Clinical Trials 1996;17:1‐12.

Ruhl 1993

Ruhl R, Halpern GM, Gershwin ME. Unconventional approaches to drug therapy in severe asthma. Allergologia et Immunopathologia 1993;21(2):53‐60.

Walker 2006

Walker S, Monteil M, Phelan K, Lasserson TJ, Walters EH. Anti‐IgE for chronic asthma in adults and children. Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD003559.pub3]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Roberts 1988

Methods

DESIGN Randomised controlled cross‐over trial
METHOD OF RANDOMISATION: Not stated
CONCEALMENT OF RANDOMISATON: Not stated
BLINDING: Double‐blind
DESCRIPTION OF WITHDRAWALS/
DROPOUTS: all completed
JADAD SCORE: 3

Participants

Enrolled into study N = 9
Withdrawals/dropouts: N =0
Completing trial: N = 9

Age: Mean (SD) 44 (10.3)
range 29‐58
Sex: (M/F) 3/6
Severity: chronic steroid dependent
Patient selection:
Source Unspecified
Inclus. criteria: None stated, but minimum one year use of oral steroids
Excl. criteria:
None stated

Interventions

Hydroxychloroquine = 400 mg/day
Control treatment = Placebo
Duration of study = 20 weeks
12 weeks run in
8 weeks = treatment/placebo
2 weeks washout
8 weeks ‐ treatment/placebo
Original dose of prednisolone used during the washout period.

Outcomes

Reduction in oral prednisolone
Visual analogue symptom scores
Beta 2 agonist
FEV1
PFR (am & pm

Notes

TAPERING OF STEROID USE: Classified B
Run‐in period, but no tapering of oral steroids attempted
PRIOR INHALED STEROID USE: Classified as A
All but one patient on high dose inhaled beclomethasone (A)
REGIME FOR REDUCING ORAL STEROID USE ON TRIAL:
After 1st week patients asked to reduce steroid dose by 1 mg per week. If asthma symptoms worsened, extra 10 mgs on that day.
If this was necessary on any 3 days in 2 weeks period then patient increased steroid dose by 5 mgs/pre‐trial dose

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Characteristics of excluded studies [ordered by study ID]

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Study

Reason for exclusion

Charous 1990

Open trial

Charous 1991

Cohort study

Hiragi 1964

Case study.

Isomaki 1968

Double‐blind, parallel group study. Randomisation not mention. Authors contacted, but no response forthcoming

Spector 1997

Review article.

Stern 1960

Double‐blind quasi experiment (alternate allocation) investigating the efficacy of Aralen versus placebo rather than as a steroid sparing agent for non‐steroid dependent asthmatics.

Tennenbaum 1966

Open trial

Data and analyses

Open in table viewer
Comparison 1. Chloroquine + steroid versus placebo + steroid

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Oral steroid consumption (change from baseline) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 1.1
Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 1 Oral steroid consumption (change from baseline).

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 1 Oral steroid consumption (change from baseline).

2 Symptoms Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 1.2
Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 2 Symptoms.

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 2 Symptoms.

3 Peak flow (am) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 1.3
Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 3 Peak flow (am).

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 3 Peak flow (am).

4 Peak flow (pm) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 1.4
Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 4 Peak flow (pm).

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 4 Peak flow (pm).

5 FEV1 Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 1.5
Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 5 FEV1.

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 5 FEV1.

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 1 Oral steroid consumption (change from baseline).
Figuras y tablas -
Analysis 1.1

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 1 Oral steroid consumption (change from baseline).

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Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 2 Symptoms.
Figuras y tablas -
Analysis 1.2

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 2 Symptoms.

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Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 3 Peak flow (am).
Figuras y tablas -
Analysis 1.3

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 3 Peak flow (am).

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Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 4 Peak flow (pm).
Figuras y tablas -
Analysis 1.4

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 4 Peak flow (pm).

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Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 5 FEV1.
Figuras y tablas -
Analysis 1.5

Comparison 1 Chloroquine + steroid versus placebo + steroid, Outcome 5 FEV1.

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Table 1. Side‐effects noted in non‐randomised studies

Trials

N

Duration

SEs noted

Isomaki 1968

19 (no withdrawals)

28 weeks

Nausea (n = 1). No other SEs related to treatment were noted. No participants withdrew as a result of SEs.

Stern 1960

13 completed out of 25

Described as 'long‐term'. Treatment given ranged from 9 weeks to 1 year

No serious toxic effect noted. Chloroquine: Nausea n = 1. Three participants switched from chloroquine to placebo due to adverse effects

Tennenbaum 1966

4 (all completed)

6 months

Early keratopathy in one patient. No other SEs reported. Mild nausea (n = 1)

Charous 1991

14

12 months

Non reported.
Figuras y tablas -
Table 1. Side‐effects noted in non‐randomised studies
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Comparison 1. Chloroquine + steroid versus placebo + steroid

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Oral steroid consumption (change from baseline) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Symptoms Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Peak flow (am) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Peak flow (pm) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 FEV1 Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Chloroquine + steroid versus placebo + steroid
Ir a la tabla de la revisión