Hydroxychloroquine and Risk of Long QT Syndrome in Rheumatoid Arthritis: A Veterans Cohort Study With Nineteen-Year Follow-up.

Autor: Quiñones ME; Veterans Affairs Medical Center, and Howard University, Washington, DC., Joseph JK; Veterans Affairs Medical Center, Washington, DC., Dowell S; Veterans Affairs Medical Center, and Howard University, Washington, DC., Moore HJ; Veterans Affairs Medical Center, Georgetown University, George Washington University, Uniformed Services University, and US Department of Veterans Affairs, Washington, DC., Karasik PE; Veterans Affairs Medical Center, Georgetown University, George Washington University, and Uniformed Services University, Washington, DC., Fonarow GC; University of California, Los Angeles, CA., Fletcher RD; Veterans Affairs Medical Center, Washington, DC., Cheng Y; Veterans Affairs Medical Center and George Washington University, Washington, DC., Zeng-Treitler Q; Veterans Affairs Medical Center and George Washington University, Washington, DC., Arundel C; Veterans Affairs Medical Center, George Washington University, and Uniformed Services University, Washington, DC., Liappis AP; Veterans Affairs Medical Center, George Washington University, and Uniformed Services University, Washington, DC., Sheriff HM; Veterans Affairs Medical Center and George Washington University, Washington, DC., Zhang S; Veterans Affairs Medical Center, Washington, DC., Taub DD; Veterans Affairs Medical Center and George Washington University, Washington, DC., Heimall MS; Veterans Affairs Medical Center, Washington, DC., Faselis C; Veterans Affairs Medical Center, George Washington University, and Uniformed Services University, Washington, DC., Kerr GS; Veterans Affairs Medical Center, Howard University, and Georgetown University, Washington, DC., Ahmed A; Veterans Affairs Medical Center, Georgetown University, and George Washington University, Washington, DC.
Jazyk: angličtina
Zdroj: Arthritis care & research [Arthritis Care Res (Hoboken)] 2023 Jul; Vol. 75 (7), pp. 1571-1579. Date of Electronic Publication: 2023 Jan 31.
DOI: 10.1002/acr.25005
Abstrakt: Objective: Recent evidence suggests that hydroxychloroquine use is not associated with higher 1-year risk of long QT syndrome (LQTS) in patients with rheumatoid arthritis (RA). Less is known about its long-term risk, the examination of which was the objective of this study.
Methods: We conducted a propensity score-matched active-comparator safety study of hydroxychloroquine in 8,852 veterans (mean age 64 ± 12 years, 14% women, 28% Black) with newly diagnosed RA. A total of 4,426 patients started on hydroxychloroquine and 4,426 started on another nonbiologic disease-modifying antirheumatic drug (DMARD) and were balanced on 87 baseline characteristics. The primary outcome was LQTS during 19-year follow-up through December 31, 2019.
Results: Incident LQTS occurred in 4 (0.09%) and 5 (0.11%) patients in the hydroxychloroquine and other DMARD groups, respectively, during the first 2 years. Respective 5-year incidences were 17 (0.38%) and 6 (0.14%), representing 11 additional LQTS events in the hydroxychloroquine group (number needed to harm 403; [95% confidence interval (95% CI)], 217-1,740) and a 181% greater relative risk (95% CI 11%-613%; P = 0.030). Although overall 10-year risk remained significant (hazard ratio 2.17; 95% CI 1.13-4.18), only 5 extra LQTS occurred in hydroxychloroquine group over the next 5 years (years 6-10) and 1 over the next 9 years (years 11-19). There was no association with arrhythmia-related hospitalization or all-cause mortality.
Conclusions: Hydroxychloroquine use had no association with LQTS during the first 2 years after initiation of therapy. There was a higher risk thereafter that became significant after 5 years of therapy. However, the 5-year absolute risk was very low, and the absolute risk difference was even lower. Both risks attenuated during longer follow-up. These findings provide evidence for long-term safety of hydroxychloroquine in patients with RA.
(© 2022 American College of Rheumatology. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)
Databáze: MEDLINE
Externí odkaz: