Hydroxychloroquine versus phlebotomy in the treatment of porphyria cutanea tarda

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Abstract
Hydroxychloroquine and phlebotomy were compared in the treatment of porphyria cutanea tarda (PCT). Patients [30] received hydroxychloroquine (200 mg twice/wk) for 1 yr and 31 underwent twice/mo. phlebotomies of 400 ml whole blood each, also for 1 yr. Clinical signs of disease improved equally in both groups. At the end of the year, urinary porphyrin excretion had significantly improved in 22 out of 30 hydroxychloroquine-treated subjects, but in only 8 out of the 31 patients who received phlebotomy. Liver histology showed significant regression of steatosis and siderosis in both groups compared with the pretrial biopsy, but the activity of liver disease, as judged by the extent of necrosis, inflammation and fibrosis, worsened in 12 hydroxychloroquine and in 7 phlebotomy-treated patients. Evidently hydroxychloroquine is more effective than phlebotomy in decreasing porphyrin production. Long-term hydroxychloroquine treatment may favor the progression of the chronic liver disease associated with PCT.

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