类风湿关节炎和系统性红斑狼疮中新使用者羟氯喹的心律失常风险：一项基于人群的研究。
Risk of Arrhythmia Among New Users of Hydroxychloroquine in Rheumatoid Arthritis and Systemic Lupus Erythematosus: A Population-Based Study.
机构信息
Arthritis Research Canada, Vancouver, Canada, and Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
Arthritis Research Canada, Vancouver, Canada.
出版信息
Arthritis Rheumatol. 2023 Mar;75(3):475-484. doi: 10.1002/art.42337. Epub 2023 Jan 11.
OBJECTIVES
We assessed the association between hydroxychloroquine (HCQ) initiation and risk of arrhythmia among patients with incident rheumatoid arthritis (RA) or with incident systemic lupus erythematosus (SLE).
METHODS
All patients with incident RA or SLE and no arrhythmic events, not receiving antiarrhythmic medications, and not receiving HCQ prior to the index date of disease in British Columbia, Canada, between January 1996 and December 2014 were identified from administrative databases. We identified patients who were dispensed HCQ prescriptions (HCQ initiators) or were not dispensed HCQ prescriptions (HCQ noninitiators) during each study year; groups were matched 1:1 by propensity scores using baseline confounders on demographics, comorbidities, medications, and health care utilization. Outcomes were any new arrhythmias, atrial fibrillation, abnormal electrocardiograms, including long QT syndrome and conduction disorder, and other unspecified arrhythmias during follow-up. We used cause-specific Cox proportional hazards models with death as a competing event to assess the association between HCQ initiation and the outcomes.
RESULTS
We identified 11,518 propensity score-matched patients with RA or SLE in each group. Over the mean follow-up of 8 years, there were 1,610 and 1,646 incident arrhythmias in the HCQ initiator group and the noninitiator group, respectively, with crude incidence rates of arrhythmia of 17.5 and 18.1 in 1,000 persons per year, respectively. The adjusted cause-specific hazard ratio (cHR) for patients who received HCQ was 0.96 (95% confidence interval [95% CI] 0.89-1.03) compared with HCQ noninitiators, and the cHRs for patients who took HCQ and had arrhythmia subtypes of atrial fibrillation, abnormal electrocardiograms, and other unspecified arrhythmias were 0.93 (95% CI 0.83-1.04), 0.98 (95% CI 0.87-1.11), and 0.95 (95% CI 0.84-1.07), respectively.
CONCLUSION
Risk of any type of arrhythmia was not increased among new users of HCQ.
目的
我们评估了羟氯喹（HCQ）起始治疗与新发类风湿关节炎（RA）或新发系统性红斑狼疮（SLE）患者心律失常风险之间的关联。
方法
从加拿大不列颠哥伦比亚省的行政数据库中，确定了所有无心律失常事件、未接受抗心律失常药物治疗且在 1996 年 1 月至 2014 年 12 月期间疾病索引日期前未使用 HCQ 的新发 RA 或 SLE 患者。我们确定了在每个研究年内开具 HCQ 处方（HCQ 起始者）或未开具 HCQ 处方（HCQ 非起始者）的患者；使用基于人口统计学、合并症、药物和医疗保健利用的基线混杂因素，通过倾向评分进行 1:1 匹配。主要结局为随访期间新发心律失常、心房颤动、异常心电图（包括长 QT 综合征和传导障碍）和其他未特指的心律失常。我们使用以死亡为竞争事件的特定原因 Cox 比例风险模型来评估 HCQ 起始治疗与结局之间的关联。
结果
我们在每个组中都确定了 11518 名经倾向评分匹配的 RA 或 SLE 患者。在平均 8 年的随访中，HCQ 起始者组和非起始者组分别有 1610 例和 1646 例新发心律失常，每年每 1000 人心律失常的粗发生率分别为 17.5 和 18.1。与 HCQ 非起始者相比，接受 HCQ 的患者的校正特定病因危险比（cHR）为 0.96（95%置信区间[95%CI]为 0.89-1.03），而服用 HCQ 且发生心房颤动、异常心电图和其他未特指心律失常亚组的患者的 cHR 分别为 0.93（95%CI 为 0.83-1.04）、0.98（95%CI 为 0.87-1.11）和 0.95（95%CI 为 0.84-1.07）。
结论
HCQ 新使用者心律失常风险并未增加。
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