Long-Term Hydroxychloroquine Therapy and Risk of Coronary Artery Disease in Patients with Systemic Lupus Erythematosus

Yang, Deng‐Ho; Leong, Pui‐Ying; Sia, Sung-Kien; Wang, Yu‐Hsun; Wei, James Cheng‐Chung

doi:10.3390/jcm8060796

Cited by 34 publications

(33 citation statements)

References 38 publications

(40 reference statements)

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“…Moreover, in a population-based retrospective cohort study, it was found that lesser risk of coronary artery disease occurred in 173 rheumatoid patients treated with HCQ [ 128 ]. A similar finding was noted in the retrospective cohort by Yang et al investigating 795 SLE patients receiving HCQ [ 129 ]. Apart from this, another prospective cohort study by involving 169 rheumatoid arthritis patients showed that 42 patients on HCQ therapy had lower levels of serum LDL and triglyceride, and therefore were at a lower risk of CVD [ 130 ].…”

Section: Cardiovascular Involvement In Covid-19 Patientssupporting

confidence: 87%

“…No comparison group Gupta et al [ 141 ] (2016, Retrospective cohort study) 1646 SLE Patients, from which HCQ usage by 754 patients 67% decreased risk of atrial fibrillation No clear limitations given. No comparison group Yang et al [ 129 ] (2019, Retrospective cohort study) 795 SLE patients given HCQ Lower risk of coronary artery disease, however no lowering of stroke No clear limitations given. No comparison group …”

Section: Cardiovascular Involvement In Covid-19 Patientsmentioning

confidence: 99%

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COVID-19, hydroxychloroquine and sudden cardiac death: implications for clinical practice in patients with rheumatic diseases

et al. 2021

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Sudden cardiac death is commonly seen due to arrhythmias, which is a common cardiac manifestation seen in COVID-19 patients, especially those with underlying cardiovascular disease (CVD). Administration of hydroxychloroquine (HCQ) as a potential treatment option during SARS-CoV-2, initially gained popularity, but later, its safe usage became questionable due to its cardiovascular safety, largely stemming from instances of cardiac arrhythmias in COVID-19. Moreover, in the setting of rheumatic diseases, in which patients are usually on HCQ for their primary disease, there is a need to scale the merits and demerits of HCQ usage for the treatment of COVID-19. In this narrative review, we aim to address the association between usage of HCQ and sudden cardiac death in COVID-19 patients. MEDLINE, EMBASE, ClinicalTrials.gov and SCOPUS databases were used to review articles in English ranging from case reports, case series, letter to editors, systematic reviews, narrative reviews, observational studies and randomized control trials. HCQ is a potential cause of sudden cardiac death in COVID-19 patients. As opposed to the reduction in CVD with HCQ in treatment of systemic lupus erythematous, rheumatoid arthritis, and other rheumatic diseases, safe usage of HCQ in COVID-19 patients is unclear; whereby, it is observed to result in QTc prolongation and Torsades de pointes even in patients with no underlying cardiovascular comorbidity. This is occasionally associated with sudden cardiac death or cardiac arrest; hence, its clinical efficacy needs further investigation by large-scale clinical trials.

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Section: Cardiovascular Involvement In Covid-19 Patientssupporting

confidence: 87%

Section: Cardiovascular Involvement In Covid-19 Patientsmentioning

confidence: 99%

COVID-19, hydroxychloroquine and sudden cardiac death: implications for clinical practice in patients with rheumatic diseases

et al. 2021

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“…Whereas the relation between immunosuppressive steroids and atherosclerosis remains controversial (Wu et al, 2016), hydroxychloroquine (HCQ), an alkalinizing lysosomatropic drug for SLE treatment, has been attested to be atheroprotective and is effective in dampening disease activity and mortality, reducing required steroids dosages, and preventing organ damage accrual and thrombovascular events ( Fig. 3; Fasano et al, 2017;Ponticelli and Moroni, 2017;Yang et al, 2019). Mechanistically, the atheroprotective effects of HCQ may be due to interfering with IFN-α and TNF production by TLR7/TLR9activated pDCs in SLE individuals (Table 1 and Fig.…”

Section: Anti-ifn/ifnar Signaling Therapiesmentioning

confidence: 99%

Type-I interferons in atherosclerosis

Chen

Tas

Winther

2019

Journal of Experimental Medicine

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The contribution of dyslipidemia and inflammation in atherosclerosis is well established. Along with effective lipid-lowering treatments, the recent success of clinical trials with anti-inflammatory therapies and the accelerated atherosclerosis in many autoimmune diseases suggest that targeting inflammation may open new avenues for the prevention and the treatment for cardiovascular diseases (CVDs). In the past decades, studies have widened the role of type-I interferons (IFNs) in disease, from antivirus defense to autoimmune responses and immuno-metabolic syndromes. While elevated type-I IFN level in serum is associated with CVD incidence in patients with interferonopathies, experimental data have attested that type-I IFNs affect plaque-residing macrophages, potentiate foam cell and extracellular trap formation, induce endothelial dysfunction, alter the phenotypes of dendritic cells and T and B lymphocytes, and lead to exacerbated atherosclerosis outcomes. In this review, we discuss the production and the effects of type-I IFNs in different atherosclerosis-associated cell types from molecular biology studies, animal models, and clinical observations, and the potential of new therapies against type-I IFN signaling for atherosclerosis.

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“…Yang et al. [ 31 ] in 2019 found a decreased risk for coronary artery disease in patients with systemic lupus erythematosus receiving high doses of HCQ for at least 318 days. Shapiro and Levy [ 32 ] in 2017 found decreased mortality with HCQ.…”

Section: Resultsmentioning

confidence: 99%

Hydroxychloroquine is protective to the heart, not harmful: a systematic review

Prodromos¹,

Rumschlag²,

Perchyk³

2020

New Microbes and New Infections

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Hydroxychloroquine (HCQ) has been shown to be at least somewhat effective in treating patients with coronavirus disease 2019 (COVID-19). Recently the US Food and Drug Administration and Centers for Disease Control and Prevention warnings of fatal cardiac toxicity from torsades de pointes (TDP) arrhythmia from HCQ receipt have been made, notwithstanding the long safe provision of HCQ to treat lupus and rheumatoid arthritis. This has resulted in restricted access of HCQ for COVID-19 treatment. We hypothesized that HCQ and azithromycin have not been reported to cause significant acute cardiac arrhythmic mortality. We performed a literature search for the effects of HCQ and azithromycin on the heart. No TDP or related deaths were found to have been reported as a result of HCQ and azithromycin receipt in the peer-reviewed literature. On the contrary, HCQ and azithromycin were both found to substantially reduce cardiac mortality and also decrease thrombosis, arrhythmia and cholesterol in treated patients in recent peer-reviewed studies and meeting presentations. HCQ and azithromycin do not cause TDP cardiac mortality; rather, HCQ decreases cardiac events. HCQ should not be restricted in COVID-19 patients out of fear of cardiac mortality.

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Long-Term Hydroxychloroquine Therapy and Risk of Coronary Artery Disease in Patients with Systemic Lupus Erythematosus

Cited by 34 publications

References 38 publications

COVID-19, hydroxychloroquine and sudden cardiac death: implications for clinical practice in patients with rheumatic diseases

COVID-19, hydroxychloroquine and sudden cardiac death: implications for clinical practice in patients with rheumatic diseases

Type-I interferons in atherosclerosis

Hydroxychloroquine is protective to the heart, not harmful: a systematic review

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