DESTIN, Fla. — Treatment with hydroxychloroquine was associated with a 67% reduced risk for atrial fibrillation in patients with systematic lupus erythematosus, according to a presenter at the North American Young Rheumatology Investigator Forum.
“About 10% of all lupus cases are shown to have arrhythmias,” Alisha Gupta, MD, MBBS, of the Allegheny Health Network Department of Medicine, told attendees. “Atrial fibrillation is the most common of the arrhythmias, with a population of more than 30 million having it. Autoimmune diseases like rheumatoid arthritis and SLE can increase the risk for atrial fibrillation, and the risk is higher among older patients. Hydroxychloroquine is a derivative of quinidine, which is itself considered a class 1A antiarrhythmic drug.”
To evaluate the association between hydroxychloroquine and atrial fibrillation or ventricular arrhythmias among individuals with SLE, Gupta and colleagues conducted a retrospective cohort study of adult patients at a tertiary academic rheumatology practice from Dec. 1, 2014, to May 30, 2017. Excluding patients with prevalent atrial fibrillation, the researchers included 1,646 patients with SLE in their study, with each categorized as either a hydroxychloroquine user or nonuser. A total of 754 of the included patients were categorized as hydroxychloroquine users.
The primary outcome was atrial fibrillation, as determined by a review of electronic health records with electrocardiogram confirmation. Occurrences of atrial fibrillation in the first year of observation were defined as prevalent cases and were excluded from the study. The secondary outcome was incident ventricular arrhythmias, defined as a composite of ventricular tachycardia, ventricular fibrillation, torsade de pointes and sudden cardiac death.
The researchers calculated the association between hydroxychloroquine and atrial fibrillation using multivariate regression analysis, adjusting for demographics, atrial fibrillation co-morbidities, the use of anti-arrhythmic medication and autoimmune serologies.
According to Gupta, there were five occurrences of incident atrial fibrillation among patients treated with hydroxychloroquine (multivariate OR = 0.33; 95% CI, 0.12-0.91), compared with 18 events in the nonuser group. Among patients treated with hydroxychloroquine, there were six incidents of ventricular arrhythmia, compared with three among nonusers (OR = 2.49; 95% CI, 0.62-9.9). In patients older than 65 years, the OR was 0.4 (95% CI, 0.13-1.25).
“In light of the cardiovascular risk benefits of hydroxychloroquine and its relation to quinidine, if these preliminary results are confirmed in larger studies, our findings may be used as rationale for a randomized study of hydroxychloroquine’s protective role against atrial fibrillation in high-risk patients with SLE,” Gupta said. “Hydroxychloroquine can be possibly needed by lupus patients not only for their primary disease but also to reduce the risk for atrial fibrillation, which would change the way we use hydroxychloroquine today.” – by Jason Laday
Gupta A. Association of hydroxychloroquine use and incident atrial fibrillation in rheumatoid arthritis: A retrospective study. Presented at: North American Young Rheumatology Investigator Forum; May 1, 2019; Destin, Fla.
Disclosure: Gupta reports no relevant financial disclosures.