Long term use of HCQS linked to increased cardiovascular mortality risk
Long term use of
hydroxychloroquine for the treatment of rheumatoid arthritis may
increase cardiovascular mortality risk but its short-term use appears to
be safe, suggests a recent study in The Lancet Rheumatology. Further,
it was found that even in the short term the addition of azithromycin
increase the risk of cardiovascular mortality and heart failure.
Hydroxychloroquine, a drug used commonly for rheumatoid arthritis
treatment has received negative publicity owing to adverse events
associated with its authorization for emergency use for treating
patients with COVID-19 pneumonia. Jennifer C E Lane, University of
Oxford, Oxford, UK, and colleagues studied the safety of
hydroxychloroquine, alone and in combination with azithromycin for
determining the risk associated with its use in routine care for
patients with rheumatoid arthritis.
The researchers
compared patients with rheumatoid arthritis aged 18 years or older and
initiating hydroxychloroquine with those initiating sulfasalazine and
followed up over 30 days, with 16 severe adverse events studied. To
further establish safety in wider populations, self-controlled case
series were done. It included all users of hydroxychloroquine regardless
of rheumatoid arthritis status or indication. The researchers also
separately studied severe adverse events associated with
hydroxychloroquine plus azithromycin (compared with hydroxychloroquine
plus amoxicillin).
The data consisted of
14 sources of claims data or electronic medical records from Germany,
Japan, the Netherlands, Spain, the UK, and the USA. It included 956 374
users of hydroxychloroquine, 310 350 users of sulfasalazine, 323 122
users of hydroxychloroquine plus azithromycin, and 351 956 users of
hydroxychloroquine plus amoxicillin.
Key findings of the study include:
No excess risk of severe adverse events was identified when 30-day
hydroxychloroquine and sulfasalazine use were compared.
Self-controlled case series confirmed these findings.
Long-term use of hydroxychloroquine appeared to be associated with
increased cardiovascular mortality (calibrated HR 1·65).
Addition of azithromycin appeared to be associated with an increased
risk of 30-day cardiovascular mortality (calibrated HR 2·19), chest
pain or angina (1·15 ), and heart failure (1·22).
Based on the findings
we call for careful consideration of the benefit-risk trade-off when
counseling those on hydroxychloroquine treatment," concluded the
authors.
The study, "Risk of hydroxychloroquine alone and in combination with
azithromycin in the treatment of rheumatoid arthritis: a multinational,
retrospective study," is published in the journal The Lancet
Rheumatology.