Metabolic Effects of Hydroxychloroquine

Hydroxychloroquine is a medicine that has been used for a long time to treat patients with
malaria, rheumatoid arthritis, lupus and other conditions. It is closely related to
chloroquine but with a better side effect profile for long term use. In treating these
conditions it was discovered to have some beneficial properties like lowering cholesterol and
lowering sugar in the blood of those who have diabetes. The mechanisms underlying these
effects are unknown. In animal studies, we have discovered that chloroquine appears to
decrease glucose, lower blood pressure and decrease atherosclerosis (hardening of the
arteries). This collection of problems commonly occurs in the metabolic syndrome and diabetes
mellitus, which affects over 20% and 7% of adults in Western countries respectively. We have
recently looked at the effects of chloroquine on the metabolic syndrome in humans which
showed that small doses given for a short period of time would reduce insulin resistance in
patients with the metabolic syndrome. Several population studies have shown similar effects
with hydroxychloroquine. Since hydroxychloroquine is similar to chloroquine, we thus expect
similar effects on blood glucose, blood pressure and blood cholesterol in type 2 diabetes.
This offers a unique opportunity to develop a novel approach for lowering blood pressure,
lipids (cholesterol and triglycerides), and glucose in people at risk for heart disease

Inclusion Criteria:

- Subjects between the age of 18 and 75, either gender, any ethnic group

- Subjects must have type 2 diabetes and the following:

- A1c of 6.5-9.0%

- Treated with at least 1000 mg of metformin daily with or without a dipeptidyl
peptidase-4(DPP4)inhibitor, a sulfonylurea (glipizide, glyburide,
glimepiride),bromocriptine or colesevelam.

- Subjects should have a BMI >27

Exclusion Criteria:

- Prior treatment with chloroquine or hydroxychloroquine as follows:

1. any exposure in the past 2 years,

2. >30 days of therapy if exposure was between 2 and 5 years ago,

3. >90 days of therapy if exposure was between 5 and 10 years ago,

4. >6 months of therapy if exposure was 10 to 20 years ago,

5. >1 year of therapy if exposure was 20 to 30 years ago,

6. No limit if last exposure was >30 years ago, e.g. during the Vietnam conflict.

- Morbid obesity (BMI >45)

- Coronary artery disease or other vascular disease

- History of stroke

- Serum creatinine >-4 mg/dl for women and >-5 mg/dl for men.

- Seizure disorder

- History of psoriasis

- Hematologic disorders, including anemia (WHO criteria for anemia:hemoglobin <13g/dL in
men and <12 g/dL in women)

- Current malignancy or active treatment for recurrence prevention,e.g. tamoxifen.
Cancer considered to be cured, either as a result of surgery or other treatment is not
exclusionary.

- Asthma requiring daily beta agonist therapy or intermittent oral steroids is
exclusionary. Inhaled steroids are acceptable. Obstructive sleep apnea will be allowed
if continuous positive airway pressure(CPAP) or other therapy has been stable for 6
months. Other active respiratory diseases are excluded.

- Treatment with 50mg or greater of Metoprolol or treatment with digoxin

- Liver disease, or Liver Function Test >2 times normal

- Active infection (including HIV)

- Serious illness requiring ongoing medical care or medication

- Treatment with atypical anti-psychotic medication. Treatment with any other medication
for psychiatric illness, unless on a stable dose for 6 weeks prior to enrollment.
Patients with unstable psychiatric disorders are excluded per the decision of the
study MD regardless of medication history.

- Taking any of the following lipid lowering medications: niacin, fibrates, and greater
than 1 gm/day of fish oils

- Uncontrolled hypertension (BP >150/90 mm Hg) at enrollment

- Need for daily Over The Counter medications, or currently taking cimetidine or >1000
IU vitamin E daily and unwilling to reduce or discontinue vitamin E or discontinue
cimetidine for the duration of the study. Patients taking more than 1000 IU vitamin E
daily should reduce or discontinue the vitamin for 30 days before randomization.

- Pregnant or lactating women, or women intending to become pregnant

- Women not using adequate birth control (hormonal birth control is acceptable, also
double barrier)

- QT corrected >450 msec on screening ECG

- Glucose-6-phosphate dehydrogenase (G6PD) deficiency