Hydroxychloroquine Does Not Increase Risk for Arrhythmia in Patients With SLE and RA

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Researchers evaluated the link between hydroxychloroquine use and corrected QT length in patients with SLE and RA without cardiovascular disease.

In patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), corrected QT (QTc) length was similar among hydroxychloroquine (HCQ) and non-HCQ users, according to study results published in Arthritis Research & Therapy.

Recent reports of HCQ use and fatal arrythmias in patients with COVID-19 have raised concerns about the cardiovascular safety of the medication.

In the current study, the researchers examined the association between HCQ use and QTc in a cohort of patients with SLE and RA.

One SLE cohort from the Columbia University Lupus Cohort Registry and 2 RA cohorts from the Evaluation of Subclinical Cardiovascular Disease and Predictors of Events in RA (ESCAPE-RA) study and the Rheumatoid Arthritis: Study of the Myocardium (RHYTHM-RA) were analyzed retrospectively. Patients were excluded if they had prior cardiovascular disease. Electrocardiogram (ECG) data were analyzed for QTc length as a continuous variable or categorial variable with cutoffs of at least 440 ms and at least 500 ms.

The combined cohort included 530 patients (352 with SLE and 178 with RA). Of these, 70% reported HCQ use at the time of ECG assessment, 44% had a QTc length of at least 440 ms, and 7% had a QTc length of at least 500 ms. There was no significant difference in the adjusted mean QTc length between HCQ users and non-HCQ users (438 ms vs 437 ms, respectively).

In adjusted multivariable analysis, HCQ use did not predict a QTc of at least 440 ms (odds ratio [OR], 0.77; 95%CI, 0.48-1.23; P =.27). It was observed that HCQ use was inversely associated with a QTc of at least 500 ms (OR, 0.39; 95% CI, 0.16-0.98; P =.044).

The researchers found a significant interaction between HCQ use and antipsychotic use. Overall, QTc length was similar with HCQ use compared with HCQ plus any type of QTc prolonging medication (433 ms vs 434 ms, respectively).

Limitations of the study included lack of data on HCQ adherence, cumulative dose, and length of therapy; lack of prior ECGs for comparison; and the exclusion of patients with prior cardiovascular disease.

“QTc length did not significantly differ in HCQ users compared with non-HCQ users, nor was it associated with a QTc [of at least] 440 ms, even while adjusting for potential confounders,” the researchers concluded. “Our data [suggest] that HCQ does not increase the arrhythmogenic risk for patients with rheumatologic conditions.”


Park E, Giles JT, Perez-Recio T, et al. Hydroxychloroquine use is not associated with QTc length in a large cohort of SLE and RA patients. Arthritis Res Ther. Published online October 29, 2021. doi:10.1186/s13075-021-02646-0

This article originally appeared on Rheumatology Advisor