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

作者：Mercedes Quinones, Joyce K. Joseph, Sharon Dowell, H. J. Moore, Pamela Karasik, Gregg C. Fonarow, Ross D. Fletcher, Yan Cheng, Qing Zeng‐Treitler, Cherinne Arundel, Angelike P. Liappis, Helen Sheriff, Sijian Zhang, Daniel D. Taub, Michael S. Heimall, Charles Faselis, Gail S. Kerr, Ali Ahmed · 发表于：Arthritis Care & Research · 年份：2022 · DOI：10.1002/acr.25005 · 被引用次数：11 · 研究领域：Drug-Induced Ocular Toxicity、Rheumatoid Arthritis Research and Therapies、Cardiac electrophysiology and arrhythmias

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: Hydroxyc...