According to a study, hydroxychloroquine (HCQ) does not contribute to the development of heart failure (HF) in rheumatoid arthritis (RA) patients.
"To our knowledge, this is the first
population-based investigation to quantify the link between HCQ use and HF in
RA patients," the researchers wrote.
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| Photo: Doctor with Elderly Rheumatoid Arthritis Patient | InStyleHealth |
Residents of Olmsted County, Minnesota, who acquired
HF following RA incidence were identified in this nested case-control study
from 1980 to 2013 who had incident RA based on the 1987 American College of Rheumatology criteria. Each case was matched with a RA control who did not
develop HF based on birth year, gender, and year of RA onset.
The researchers then evaluated the information about
HCQ use, such as start and stop dates, as well as dose adjustments. They used
this information to determine the duration and cumulative dose of HCQ. Finally,
age-adjusted logistic regression models were used to investigate the link
between HCQ and HF.
The study comprised 143 people with RA who had been
diagnosed with HF (mean age 65.8 years, 62% female) and 143 people with RA who
had not been diagnosed with HF (mean age 64.5 years, 62% female).
The cumulative dose of HCQ had no effect on the risk of heart failure (odds ratio [OR] 0.96 per 100 g increase in cumulative dose, 95 percent confidence interval [CI], 0.90–1.03). Patients with a total dose of less than 300 g had no connection (OR, 0.92, 95 percent CI, 0.41–2.08). Furthermore, the duration of HCQ use in the years leading up to the index had no significant association with HF (OR, 0.98, 95 percent CI, 0.91–1.05).
"The elevated risk of cardiovascular (CV)
illness, especially HF, has been linked to the inflammatory burden
characteristic of RA," the researchers wrote. "The development of HF
in people with RA is complex, with CV risk factors and RA disease-related
variables both contributing."
A meta-analysis examining the association of HCQ and
chloroquine usage with CV risk in rheumatic patients found that HCQ users had a
lower probability of developing CV illness.
Conduction problems, restrictive cardiomyopathy, left ventricular hypertrophy, ventricular dysfunction, and valve abnormalities have all been linked to HCQ use in several studies. Instead of population-based longitudinal data, this evidence was derived mostly from case reports/series and drug monitoring reports. However, such signals were backed by two rationales.
"First, the histological appearance of HCQ
cardiotoxicity on endomyocardial biopsy has been identified. Second, clinical
and histological improvements have been recorded following the discontinuation
of HCQ, according to the researchers.
"Larger prospective studies are needed to define
the safety of higher cumulative doses of HCQ in terms of HF development, as
well as to identify the incidence of HCQ-related cardiotoxicity in patients
with RA, in order to define high-risk subgroups and the need for cardiovascular
screening," they wrote.
Source: J Rheumatol 2021;48:1508-1511