Antimalarial-induced cardiomyopathy: a systematic review of the literature

Tselios, Konstantinos; Deeb, M; Gladman, Dafna D.; Harvey, Paula; Urowitz, Murray B.

doi:10.1177/0961203317734922

Cited by 58 publications

(77 citation statements)

References 53 publications

(174 reference statements)

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“…A 2015 review of the literature and a prospective study demonstrated that the incidence of clinically significant valvular heart disease is low in the absence of a murmur in these category of patients, so in this review they suggest to screen these patients only by physical examination and echocardiogram should be reserved to patients with audible murmur as in our case and those treated for more than 5 years at high doses of cabergoline. [12] Moreover, drug induced valvulopathy is a condition that includes changes in the functionality and morphology of the valves with thickening and restriction [13,14]. The differential diagnosis is difficult, but specific echocardiographic pattern are needed to lead the way.…”

Section: Discussionmentioning

confidence: 99%

Treating the Brain But Forgetting the Heart: Mitral Valvular Disease Cabergoline Induced

Tabbah¹,

Bayeh²,

Karaminassian³

2019

CCR

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Drug induced valvular heart disease is a forgotten entity of valvular disease, sometimes underdiagnosed or even misdiagnosed. The majority of drugs found to induce this kind of disease have a common pharmacological action on a specific serotonin receptor-the 5HT2B receptor. The typical echocardiographic features in these cases are mild to moderate thickening and restriction of the valve with no commissural fusion nor calcification which is the main cause of valvular regurgitation. These findings are not coherent with rheumatic valvular disease We described a case of a 36years old female with a past medical history of hyperprolactinemia treated with low dose of cabergoline for 9 months, presenting for dyspnea on minimal exertion and palpitation. She consulted a cardiologist that discovered a systodiastolic loud murmur on apical area. A cardiac ultrasound was done revealing a mitral valve disease with moderate leaflet thickening and restriction with no commissural fusion nor calcification with a severe eccentric mitral regurgitation grade 3+ due to tenting and malcoaptation of the valve during diastole. Rheumatic and degenerative valve disease were ruled out. The final diagnosis was a drug induced valvular heart disease and more specifically a cabergoline induced mitral valve disease acting on the serotonin receptors 5HT2B. Patient was sent for surgery. Early diagnosis with a good physical examination and current echocardiographic follow up in patient with hyperprolactinemia with even low dose of cabergoline and short term treatment is suggested.

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Section: Discussionmentioning

confidence: 99%

Treating the Brain But Forgetting the Heart: Mitral Valvular Disease Cabergoline Induced

Tabbah¹,

Bayeh²,

Karaminassian³

2019

CCR

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“…Nevertheless, some rare but severe complications may occur such as anti-malarial myopathy or cardiomyopathy and antimalarial maculopathy. 73 Among the two available anti-malarial drugs, HCQ is the one with the lowest retinal toxicity. 74 Azathioprine AZA is a prodrug converted in vivo into its active metabolite, 6-mercaptopurine.…”

Section: Antimalarial Drugsmentioning

confidence: 99%

<p>Refractory Sarcoidosis: A Review</p>

Jammal

Jamilloux

Gerfaud‐Valentin

et al. 2020

TCRM

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Sarcoidosis is a multi-system disease of unknown etiology characterized by granuloma formation in various organs (especially lung and mediastinohilar lymph nodes). In more than half of patients, the disease resolves spontaneously. When indicated, it usually responds to corticosteroids, the first-line treatment, but some patients may not respond or tolerate them. An absence of treatment response is rare and urges for verifying the absence of a diagnosis error, the good adherence of the treatment, the presence of active lesions susceptible to respond since fibrotic lesions are irreversible. That is when second-line treatments, immunosuppressants (methotrexate, leflunomide, azathioprine, mycophenolate mofetil, hydroxychloroquine), should be considered. Methotrexate is the only first-line immunosuppressant validated by a randomized controlled trial. Refractory sarcoidosis is not yet a well-defined condition, but it remains a real challenge for the physicians. Herein, we considered refractory sarcoidosis as a disease in which second-line treatments are not sufficient to achieve satisfying disease control or satisfying corticosteroids tapering. Tumor necrosis alpha inhibitors, third-line treatments, have been validated through randomized controlled trials. There are currently no guidelines or recommendations regarding refractory sarcoidosis. Moreover, criteria defining non-response to treatment need to be clearly specified. The delay to achieve response to organ involvement and drugs also should be defined. In the past ten years, the efficacy of several immunosuppressants beforehand used in other autoimmune or inflammatory diseases was reported in refractory cases series. Among them, anti-CD20 antibodies (rituximab), repository corticotrophin injection, and anti-JAK therapy anti-interleukin-6 receptor monoclonal antibody (tocilizumab) were the main reported. Unfortunately, no clinical trial is available to validate their use in the case of sarcoidosis. Currently, other immunosuppressants such as JAK inhibitors are on trial to assess their efficacy in sarcoidosis. In this review, we propose to summarize the state of the art regarding the use of immunosuppressants and their management in the case of refractory or multidrugresistant sarcoidosis.

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“…In this issue of The Journal, Tselios, et al 6a , report from their cohort the diagnosis, disease course, and outcome of 8 patients with antimalarial-induced cardiomyopathy, an underrecognized complication that has been reported with longterm use and higher cumulative doses of chloroquine and HCQ 7 . To better understand the risks posed by this case series, we must first review the biological pharmacology and pharmacodynamics of HCQ.…”

Section: Hydroxychloroquine -How Much Is Too Much?mentioning

confidence: 99%