While it demonstrated some efficacy in RA as monotherapy, HCQ has really made its name is in combination therapy. The first major publication to look at a combination therapy tested MTX+HCQ, MTX+HCQ+SSZ and MTX+SSZ in patients with established RA. While “triple” did the best, MTX+SSZ did worse than either combination using HCQ. There may be an explanation for this, coming from the Oncology literature. MTX needs to be actively transported into the cells to become polyglutamated, which is the active form of MTX. It turns out that SSZ inhibits this transport system, and this inhibition is counteracted by HCQ. Makes you think twice about using MTX+SSZ without HCQ, doesn’t it?Reminds me of the current discussion about the "triple" regimen of HCQ + Azithromycin + Zinc.
“HCQ has really made its name is in combination therapy.”
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Yes. Someone posted a link to this article earlier today, and after having read it, I believed it should be posted more widely for this reason. Significant, certainly.
HCQ, by itself, doesn’t do much. It seems its effectiveness comes from facilitating zinc penetration into cells.