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.

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.

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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 strategy: 

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.

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