Iyer Priyanka, Gao Yubo, Jalal Diana, Girotra Saket, Singh Namrata, Vaughan-Sarrazin Mary
Division of Rheumatology, University of California at Irvine, Irvine, CA, USA.
Division of General Medicine, Department of Internal Medicine, Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Clin Rheumatol. 2024 Jan;43(1):87-94. doi: 10.1007/s10067-023-06714-5. Epub 2023 Jul 27.
There is little robust data about the cardiovascular safety of hydroxychloroquine in patients with rheumatoid arthritis (RA), who often have cardiovascular comorbidities. We examined the association between use of hydroxychloroquine (HCQ) in patients with RA and major adverse cardiovascular events (MACE).
In a retrospective cohort of Medicare beneficiaries aged ≥ 65 years with RA, we identified patients who initiated HCQ (users) and who did not initiate HCQ (non-users) between January 2015-June 2017. Each HCQ user was matched to 2 non-users of HCQ using propensity score derived from patient baseline characteristics. The primary outcome was the occurrence of MACE, defined as acute admissions for stroke, myocardial infarction, or heart failure. Secondary outcomes included all-cause mortality and the composite of MACE and all-cause mortality. Cox proportional hazards model was used to compare outcomes between HCQ users to non-users.
The study included 2380 RA patients with incident HCQ use and matched 4633 HCQ non-users over the study period. The mean follow-up duration was 1.67 and 1.63 years in HCQ non-users and users, respectively. In multivariable models, use of HCQ was not associated with the risk of MACE (hazard ratio 1.1; 95% CI: 0.832-1.33). However, use of HCQ was associated with a lower risk of all-cause mortality (HR: 0.54; 95% CI: 0.45-0.64) and the composite of all-cause mortality and MACE (HR 0.67; 95% CI: 0.58-0.78).
HCQ use was independently associated with a lower risk of mortality in older adults with RA but not with incidence of MACE events. Key Points • Using an incident user design (to avoid the biases of a prevalent user design) and a population-based approach, we examined the effect of hydroxychloroquine (HCQ) on the risk of major cardiovascular events (MACE) in older patients with RA. • We did not find an association between HCQ use and incident MACE. We did, however, find a significant association with the composite outcome (MACE and all-cause mortality) driven by a significant reduction in all-cause mortality with HCQ use.
关于类风湿关节炎（RA）患者使用羟氯喹的心血管安全性，几乎没有可靠数据，而这类患者常伴有心血管合并症。我们研究了RA患者使用羟氯喹（HCQ）与主要不良心血管事件（MACE）之间的关联。
在一个年龄≥65岁的RA医疗保险受益人的回顾性队列中，我们确定了2015年1月至2017年6月期间开始使用HCQ的患者（使用者）和未开始使用HCQ的患者（非使用者）。使用从患者基线特征得出的倾向评分，将每位HCQ使用者与2名HCQ非使用者进行匹配。主要结局是MACE的发生，定义为因中风、心肌梗死或心力衰竭而急性入院。次要结局包括全因死亡率以及MACE和全因死亡率的综合情况。使用Cox比例风险模型比较HCQ使用者与非使用者的结局。
在研究期间，该研究纳入了2380例新使用HCQ的RA患者，并匹配了4633例HCQ非使用者。HCQ非使用者和使用者的平均随访时间分别为1.67年和1.63年。在多变量模型中，使用HCQ与MACE风险无关（风险比1.1；95%置信区间：0.832 - 1.33）。然而，使用HCQ与较低的全因死亡率风险相关（风险比：0.54；95%置信区间：0.45 - 0.64）以及与全因死亡率和MACE的综合情况相关（风险比0.67；95%置信区间：0.58 - 0.78）。
在老年RA患者中，使用HCQ与较低的死亡风险独立相关，但与MACE事件的发生率无关。要点 • 使用新使用者设计（以避免现患使用者设计的偏差）和基于人群的方法，我们研究了羟氯喹（HCQ）对老年RA患者主要心血管事件（MACE）风险的影响。 • 我们未发现使用HCQ与新发MACE之间存在关联。然而，我们确实发现使用HCQ导致全因死亡率显著降低，从而与综合结局（MACE和全因死亡率）存在显著关联。
