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Hydroxychloroquine use is associated with reduced mortality risk in older adults with rheumatoid arthritis

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Abstract

Background

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).

Methods

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.

Results

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).

Conclusion

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.

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Acknowledgements

This work has been previously presented as an oral presentation at the Annual American College of Rheumatology meeting in 2019.

Funding

This study was funded by the Innovative Project Award (19IPLOI34760622) of the American Heart Association to Dr Singh.

Author information

Authors and Affiliations

  1. Division of Rheumatology, University of California at Irvine, Irvine, CA, USA

    Priyanka Iyer

  2. Division of General Medicine, Department of Internal Medicine, Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA, USA

    Yubo Gao

  3. Division of Nephrology, Department of Internal Medicine, Roy and Lucille Carver College of Medicine, University of Iowa, and Iowa City VA Health Care System, Iowa City, IA, USA

    Diana Jalal

  4. Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Saket Girotra

  5. Division of Rheumatology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Namrata Singh

  6. Division of General Medicine, Department of Internal Medicine, Roy and Lucille Carver College of Medicine, University of Iowa, and Iowa City VA Health Care System Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, IA, USA

    Mary Vaughan-Sarrazin

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Correspondence to Namrata Singh.

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Iyer, P., Gao, Y., Jalal, D. et al. Hydroxychloroquine use is associated with reduced mortality risk in older adults with rheumatoid arthritis. Clin Rheumatol 43, 87–94 (2024). https://doi.org/10.1007/s10067-023-06714-5

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