“In the US, hydroxychloroquine is commonly used as a first-line treatment in patients with RA, while methotrexate is the recommended first-line disease-modifying antirheumatic drug (DMARD),” Dr Elvira D’Andrea (Brigham and Women’s Hospital, MA, USA) stated [1]. In the wake of assessments on hydroxychloroquine use in COVID-19 patients, concerns regarding cardiovascular safety have been raised [2]. “We conducted a comprehensive cardiovascular safety evaluation of hydroxychloroquine compared with methotrexate in patients with RA,” Dr D’Andrea explained the aim of the presented research [1].
Data from Medicare linked to the National Death Index was used to identify a cohort of patients with RA starting on their first-line medication with either hydroxychloroquine or methotrexate. This led to 54,462 matched pairs in each group that were followed over a median time of 209 days. The composite primary outcome was defined as sudden cardiac arrest or ventricular arrhythmia and 3-point major adverse cardiovascular event. Secondary outcomes consisted of cardiovascular events as well as all-cause mortality, myocardial infarction, stroke, and hospitalised heart failure. The mean age of the cohort was 74.3 years, and 78.5% were women. Heart failure was known in 12% of the cases, and coronary artery disease in just over 24%.
In terms of the primary outcome, no significant difference was found between methotrexate (i.e. reference group) and hydroxychloroquine: HR 1.03 (95% CI 0.79–1.35) for sudden cardiac death/ventricular arrhythmia and HR 1.07 (95% CI 0.97–1.18) for major adverse cardiovascular events. The results for the secondary outcomes, however, revealed significant differences between the groups for cardiovascular and all-cause mortality. Patients treated with hydroxychloroquine had a 41% higher relative risk for heart failure hospitalisation and the HR for all-cause mortality was 1.10.
A subgroup analysis was additionally performed based on prior history of heart failure. No disparities were shown between methotrexate or hydroxychloroquine treatment in those without previously established heart failure, but they were found for hospitalisation due to heart failure (HR 1.63 in favour of methotrexate). “Hydroxychloroquine use appears to be associated with increased risk of major adverse cardiovascular events, cardiovascular mortality, all-cause mortality, and myocardial infarction in patients with a history of heart failure. An increased risk of hospitalisation for heart failure was observed in new users of hydroxychloroquine regardless of prior history of heart failure,” Dr D’Andrea said in her final remarks.
- D’Andrea E. Cardiovascular risk of hydroxychloroquine in the treatment of a rheumatoid arthritis: a retrospective cohort study. Abstract L11, ACR Convergence 2021, 3–10 November.
- Desmarais J, et al. Arthritis Rheumatol. 2021 Oct 26. Online ahead of print.
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Table of Contents: ACR 2021
Featured articles
Late-Breaking Abstracts
Vaccine booster improves immune response in patients treated with rituximab
IL-17 inhibition showing efficacy in GCA in phase 2 trials
Spotlight on Rheumatoid Arthritis
Cycling JAK inhibitors shows similar effectiveness to switching to a bDMARD in difficult-to-treat RA
Pre-existing heart failure affects safety of hydroxychloroquine in RA patients
Patients with RA-associated interstitial lung disease benefit from antifibrotic agent
Ultra-low dosing of rituximab in RA is a viable treatment option
Kidney disease and hydroxychloroquine dose are risk factors for developing retinopathy
More pros than cons for the use of statins in RA
Psoriatic Arthritis: Novel Developments
Selective IL-23 inhibition: a new option in active PsA
Ustekinumab: highly efficacious in PSA independent of methotrexate
COVID-19: What You Need to Know
Vaccinated rheumatic patients carry increased risk for COVID-19 breakthrough infections
B-cell depleting medication increases COVID-19 breakthrough infection outcome risk
COVID-19 mRNA vaccine safe and tolerable in adults with autoimmune disease
SLE Treatment: What Is New
Iberdomide: an upcoming new treatment possibility in lupus erythematosus
Sequential rituximab after belimumab does not improve disease control in SLE
Lupus patients less protected by COVID-19 vaccine
Late-Breaking Posters
Promising results in uric acid-lowering in gout patients with a new xanthine oxidase inhibitor
Laboratory and clinical signs 24h after hospitalisation predict MIS-C in children
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