Cardiovascular Safety of Hydroxychloroquine in Veterans with Rheumatoid Arthritis

• Published in: Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2021-05
• Main Authors: Faselis, Charles, Zeng-Treitler, 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
• Format: Article
• Language: English
• ISSN: 2326-5205

Hydroxychloroquine (HCQ) may prolong the QT interval, a risk factor for torsade de pointes, a potentially fatal ventricular arrhythmia. We examined the cardiovascular safety of HCQ in patients with rheumatoid arthritis (RA). We conducted an active comparator safety study of HCQ in a propensity score-matched cohort of 8852 Veterans newly diagnosed with RA between October 1, 2001, and December 31, 2017. Patients were initiated on HCQ (n=4426) or another non-biologic disease-modifying antirheumatic drug (DMARD; n=4426) after RA diagnosis, up to December 31, 2018, and followed for 12 months after therapy initiation, up to December 31, 2019. Patients had a mean age of 64 (±12) years, 14% were women, 28% African American, and were balanced on 87 baseline characteristics. There were 3 (0.03%) long QT syndrome (LQTS) events, of which 2 belonged to the HCQ group. Of the 56 (0.63%) arrhythmia-related hospitalizations, 30 belonged to the HCQ group (hazard ratio associated with HCQ, 1.16; 95% CI, 0.68-1.95). All-cause mortality occurred in 144 (3.25%) and 136 (3.07%) patients in the HCQ and non-HCQ groups, respectively (hazard ratio associated with HCQ, 1.06; 95% CI, 0.84-1.34). During the first 30 days of follow-up, there was no LQTS event, 2 arrhythmia-related hospitalizations (none in the HCQ group), and 13 deaths (6 in the HCQ group). The incidence of LQTS and arrhythmia-related hospitalization was low in patients with RA during the first year after the initiation of HCQ or another non-biologic DMARD. We found no evidence that HCQ therapy is associated with a higher risk of adverse cardiovascular events or death.