Efficiency of hydroxychloroquine in the treatment of granulomatous complications in chronic granulomatous disease.

Chronic granulomatous disease (CGD) represents a group of genetic disorders in which impaired intracellular microbial killing by phagocytes leads to recurrent bacterial and fungal infections and granuloma formation. Granulomatous lesions involved gastrointestinal tract in more than one-third of all CGD patients, with various clinical presentations, and may be life threatening. Corticosteroid therapy may relieve symptoms but increase the risk of infections in such immunocompromised patients. We report here the first successful management, with hydroxychloroquine therapy alone, of a 29-year-old CGD man with severe gastric granulomatous involvement. Hydroxychloroquine appears to be a safe and effective alternative treatment of granulomas in CGD patients.

HIBISCUS: Hydroxychloroquine for the secondary prevention of thrombotic and obstetrical events in primary antiphospholipid syndrome.

The relapse rate in antiphospholipid syndrome (APS) remains high, i.e. around 20%-21% at 5 years in thrombotic APS and 20-28% in obstetrical APS [2, 3]. Hydroxychloroquine (HCQ) appears as an additional therapy, as it possesses immunomodulatory and anti-thrombotic various effects [4-16]. Our group recently obtained the orphan designation of HCQ in antiphospholipid syndrome by the European Medicine Agency. Furthermore, the leaders of the project made the proposal of an international project, HIBISCUS, about the use of Hydroxychloroquine in secondary prevention of obstetrical and thrombotic events in primary APS. This study has been launched in several countries and at now, 53 centers from 16 countries participate to this international trial. This trial consists in two parts: a retrospective and a prospective study. The French part of the trial in thrombosis has been granted by the French Minister of Health in December 2015 (the academic trial independent of the pharmaceutical industry PHRC N PAPIRUS) and is coordinated by one of the members of the leading consortium of HIBISCUS.