QTc interval prolongation in patients with systemic lupus erythematosus treated with hydroxychloroquine

Nishiyama, Taihei; Kondo, Yuya; Tsuboi, Hiroto; Noma, Hisashi; Tabuchi, Daiki; Sugita, Takahisa; Okamoto, Susumu; Terasaki, Toshihiko; Shimizu, Masaru; Honda, Fumika; Ohyama, Ayako; Kurata, Izumi; Yagishita, Mizuki; Abe, Saori; Takahashi, Hiroyuki; Osada, Akira; Hagiwara, Shinji; Matsumoto, Isao; Sumida, Takayuki

doi:10.1080/14397595.2021.1879368

Cited by 12 publications

(11 citation statements)

References 30 publications

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“…Despite this finding, case reports for TdP and sudden death have been described for hydroxychloroquine when used for non-malaria indications [ 35 ]. In a Japanese study on systemic lupus erythematosus patients treated with hydroxychloroquine, a significant increase on the QTc was found when compared with a control group with no hydroxychloroquine exposure [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

QTc Prolongation with the Use of Hydroxychloroquine and Concomitant Arrhythmogenic Medications: A Retrospective Study Using Electronic Health Records Data

Villa‐Zapata

Boyce

Chou

et al. 2022

Drugs - Real World Outcomes

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Introduction Hydroxychloroquine can induce QT/QTc interval prolongation for some patients; however, little is known about its interactions with other QT-prolonging drugs. Objective The purpose of this retrospective electronic health records study was to evaluate changes in the QTc interval in patients taking hydroxychloroquine with or without concomitant QT-prolonging medications. Methods De-identified health records were obtained from the Cerner Health Facts ® database. Variables of interest included demographics, diagnoses, clinical procedures, laboratory tests, and medications. Patients were categorized into six cohorts based on exposure to hydroxychloroquine, methotrexate, or sulfasalazine alone, or the combination of any those drugs with any concomitant drug known to prolong the QT interval. Tisdale QTc risk score was calculated for each patient cohort. Two-sample paired t-tests were used to test differences between the mean before and after QTc measurements within each group and ANOVA was used to test for significant differences across the cohort means. Results A statistically significant increase in QTc interval from the last measurement prior to concomitant exposure of 18.0 ms (95% CI 3.5–32.5; p < 0.05) was found in the hydroxychloroquine monotherapy cohort. QTc changes varied considerably across cohorts, with standard deviations ranging from 40.9 (hydroxychloroquine monotherapy) to 57.8 (hydroxychloroquine + sulfasalazine). There was no difference in QTc measurements among cohorts. The hydroxychloroquine + QTc-prolonging agent cohort had the highest average Tisdale Risk Score compared with those without concomitant exposure ( p < 0.05). Conclusion Our analysis of retrospective electronic health records found hydroxychloroquine to be associated with a moderate increase in the QTc interval compared with sulfasalazine or methotrexate. However, the QTc was not significantly increased with concomitant exposure to other drugs known to increase QTc interval.

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Section: Discussionmentioning

confidence: 99%

QTc Prolongation with the Use of Hydroxychloroquine and Concomitant Arrhythmogenic Medications: A Retrospective Study Using Electronic Health Records Data

Villa‐Zapata

Boyce

Chou

et al. 2022

Drugs - Real World Outcomes

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“…In a separate cohort study conducted by Nishiyama et al, the primary objective was to evaluate the impact of HCQ treatment on QTc interval among patients diagnosed with SLE during the period spanning from 2015 to 2020 23 . In addition to this primary goal, the study also aimed to identify various factors that could potentially influence QTc prolongation.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, the impact of HCQ treatment on QTc interval in patients with SLE was investigated in another cohort study 23 . Although the study indicated a significant increase in the mean QTc interval in the HCQ-treated group, performing a comprehensive multiple logistic regression analysis did not reveal significant disparities between the HCQ-treated and control groups.…”

Section: Methodsmentioning

confidence: 99%

Hydroxychloroquine and the associated risk of arrhythmias

Farhat,

Kassab,

Tlaiss

et al. 2024

gcsp

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Hydroxychloroquine (HCQ), which was initially used as an antimalarial drug, is now being used to treat other illnesses, especially rheumatic autoimmune disorders such as systemic lupus erythematosus, primary Sjögren's syndrome, and rheumatoid arthritis, because it is safe, effective, and cost efficient. This drug has shown high efficacy and has become the first-line treatment for many of these diseases. Although HCQ has many therapeutic effects, it has unfortunately shown some complications, especially with its long-term use. One of these side effects is arrhythmia through prolongation of the QT interval. This narrative literature review focuses on the effects of HCQ on the QT interval in patients with rheumatologic diseases who have been prescribed this drug. In particular, we will focus on the increased risk of arrhythmia when HCQ is administered with other drugs, such as azithromycin and many others, along with drug-drug interactions. In addition, we investigated the safety of this drug in pregnant women.

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“…A wide range of side effects such as cardiovascular, dermatological, digestive, hematological, metabolic, ophthalmologic, as well as other rare side effects were reported to be associated with HCQ use. 4 , 13 , 30 , 31 , 32 , 35 , 216 – 238 The main side effects of HCQ are summarized in Table 4 .…”

Section: Hydroxychloroquine Safety Profilementioning

confidence: 99%

Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge

Dima

Jurcuţ²,

Chasset

et al. 2022

Therapeutic Advances in Musculoskeletal

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The antimalarial hydroxychloroquine (HCQ) has demonstrated several crucial properties for the treatment of systemic lupus erythematosus (SLE). Herein, we reviewed the main HCQ pharmacologic features, detailed its mechanism of action, and summarized the existing guidelines and recommendations for HCQ use in rheumatology with a systematic literature search for the randomized controlled trials focused on lupus. HCQ has been shown to decrease SLE activity, especially in mild and moderate disease, to prevent disease flare and to lower the long-term glucocorticoid need. The numerous benefits of HCQ are extended to pregnancy and breastfeeding period. Based on cohort studies, antithrombotic and metabolic HCQ’s effects were shown, including lipid-lowering properties, which might contribute to an improved cardiovascular risk. Moreover, early HCQ use in antinuclear antibodies positive individuals might delay the progression to SLE. Finally, HCQ has a significant favorable impact on long-term outcomes such as damage accrual and mortality in SLE. Based on these multiple benefits, HCQ is now the mainstay long-term treatment in SLE, recommended by current guidelines in all patients unless contraindications or side effects. The daily dose associated with the best compromise between efficacy and safety is matter of debate. The concern regarding retinal toxicity rather than proper efficacy data is the one that dictated the daily dosage of ⩽5 mg/kg/day actual body weight currently agreed upon.

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QTc interval prolongation in patients with systemic lupus erythematosus treated with hydroxychloroquine

Cited by 12 publications

References 30 publications

QTc Prolongation with the Use of Hydroxychloroquine and Concomitant Arrhythmogenic Medications: A Retrospective Study Using Electronic Health Records Data

QTc Prolongation with the Use of Hydroxychloroquine and Concomitant Arrhythmogenic Medications: A Retrospective Study Using Electronic Health Records Data

Hydroxychloroquine and the associated risk of arrhythmias

Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge

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