Hydroxychloroquine Does Not Increase the Risk of Cardiac Arrhythmia in Common Rheumatic Diseases: A Nationwide Population-Based Cohort Study

Abstract

ObjectivesHydroxychloroquine (HCQ) is widely used to treat rheumatic diseases including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and Sjögren’s syndrome (SS). Cardiac arrhythmia has been concerned as important safety issue for HCQ. The aim of this study was to investigate whether hydroxychloroquine increases new-onset arrhythmia among patients with RA, SLE or SS.MethodsThis was a retrospective cohort study that conducted from the longitudinal health insurance database of Taiwan. Patients with newly diagnosed RA, SLE or SS with age ≥20 years old were selected from 2000 to 2012. Patients who received HCQ and without HCQ treatment groups were matched by propensity score to minimize the effect of selection bias and confounders. The Cox proportional hazard model was used to analyze the risk of arrhythmia between the two groups after controlling for related variables.ResultsA total of 15892 patients were selected to participate and finally 3575 patients were enrolled in each group after matching. There was no different risk of all arrhythmia in patients using HCQ than without HCQ (adjusted hazards ratio 0.81, 95% CI 0.61–1.07) and ventricular arrhythmia as well. The incidence of arrhythmia did not increase when HCQ co-administrated with macrolides. The arrhythmia risk was also not different regardless of daily HCQ dose <400mg or ≥400mg or follow-up duration of ≦4 months or >4 months.ConclusionThe administration of HCQ did not increase the risk of all cardiac arrhythmia and ventricular arrhythmia regardless of different duration of treatment (≦4 months or >4 months) or cumulative dose (<400mg or ≥400mg) in patients with common autoimmune diseases such as RA, SLE and SS.

Wirkung von Hydroxychloroquin auf die Vorhofelektrophysiologie bei In-silico-Wildtyp- und PITX2+/--Vorhofkardiomyozyten

“…Our results suggest potential antiarrhythmic effects of HCQ against AF. Other studies have shown that HCQ treatments did not significantly increase the risk of cardiac arrhythmias, including ventricular arrhythmias, in patients with SLE [ 40 , 41 ] and common rheumatic diseases [ 42 ]. Although some case reports showed that HCQ could lead to QT prolongation [ 13 , 43 ], HCQ use was not associated with QTc length in a large cohort of patients with rheumatic diseases [ 44 ].…”

Effects of hydroxychloroquine on atrial electrophysiology in in silico wild-type and PITX2+/- atrial cardiomyocytes

“…Our results imply the potential antiarrhythmic effects of HCQ against AF. Other studies have shown that HCQ treatments did not significantly increase the risk of cardiac arrhythmias, including ventricular arrhythmias, in patients with SLE [40, 41] and common rheumatic diseases [42]. Although some case reports showed that HCQ could lead to QT prolongation [13, 43], HCQ use was not associated with QTc length in a large cohort of patients with rheumatic diseases [44].…”

Cardiovascular Disease in Primary Sjögren’s Syndrome: Raising Clinicians’ Awareness

“…Concerns regarding the use of hydroxychloroquine (HCQ), one of the most used drugs in SS, and cardiac arrhythmia have been based on the fact that HCQ can prolong the QT interval. However, in a recent ample study, it was shown that HCQ did not increase the risk of ventricular arrhythmia (regardless of cumulative dose or duration of treatment) in patients with various autoimmune diseases, including SS ( 111 ). The role of the ECG-based screening for the detection of LQTS in patients with SS is not clear.…”