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Cardiovascular Safety of Hydroxychloroquine in US Veterans With Rheumatoid Arthritis
Author(s) -
Faselis Charles,
ZengTreitler Qing,
Cheng Yan,
Kerr Gail S.,
Nashel David J.,
Liappis Angelike P.,
Weintrob Amy C.,
Karasik Pamela E.,
Arundel Cherinne,
Boehm Denise,
Heimall Michael S.,
Connell Lawrence B.,
Taub Daniel D.,
Shao Yijun,
Redd Douglas F.,
Sheriff Helen M.,
Zhang Sijian,
Fletcher Ross D.,
Fonarow Gregg C.,
Moore Hans J.,
Ahmed Ali
Publication year - 2021
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41803
Subject(s) - medicine , hydroxychloroquine , rheumatoid arthritis , hazard ratio , qt interval , confidence interval , cohort , disease , covid-19 , infectious disease (medical specialty)
Objective Hydroxychloroquine (HCQ) may prolong the QT interval, a risk factor for torsade de pointes, a potentially fatal ventricular arrhythmia. This study was undertaken to examine the cardiovascular safety of HCQ in patients with rheumatoid arthritis (RA). Methods We conducted an active comparator safety study of HCQ in a propensity score–matched cohort of 8,852 US veterans newly diagnosed as having RA between October 1, 2001 and December 31, 2017. Patients were started on HCQ (n = 4,426) or another nonbiologic disease‐modifying antirheumatic drug (DMARD; n = 4,426) after RA diagnosis, up to December 31, 2018, and followed up for 12 months after therapy initiation, up to December 31, 2019. Results Patients had a mean ± SD age of 64 ± 12 years, 14% were women, and 28% were African American. The treatment groups were balanced with regard to 87 baseline characteristics. There were 3 long QT syndrome events (0.03%), 2 of which occurred in patients receiving HCQ. Of the 56 arrhythmia‐related hospitalizations (0.63%), 30 occurred in patients in the HCQ group (hazard ratio [HR] associated with HCQ 1.16 [95% confidence interval (95% CI) 0.68–1.95]). All‐cause mortality occurred in 144 (3.25%) and 136 (3.07%) of the patients in the HCQ and non‐HCQ groups, respectively (HR associated with HCQ 1.06 [95% CI, 0.84–1.34]). During the first 30 days of follow‐up, there were no long QT syndrome events, 2 arrhythmia‐related hospitalizations (none in the HCQ group), and 13 deaths (6 in the HCQ group). Conclusion Our findings indicate that the incidence of long QT syndrome and arrhythmia‐related hospitalization is low in patients with RA during the first year after the initiation of HCQ or another nonbiologic DMARD. We found no evidence that HCQ therapy is associated with a higher risk of adverse cardiovascular events or death.