Use of Hydroxychloroquine and Risk of Major Adverse Cardiovascular Events in Patients With Lupus Erythematosus

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• In this observational cohort study based on Danish registries, cardiovascular outcomes were compared between cutaneous or systemic lupus erythematosus (LE) patients (n=4587) treated with (n=2343, 51%) or without hydroxychloroquine. Based on Cox regression models, there was an inverse association between hydroxychloroquine use and risk of major adverse cardiovascular events (myocardial infarction, stroke, or cardiovascular-associated death). This was statistically significant for systemic LE (HR, 0.65) but not cutaneous LE (HR, 0.71).

• The public awareness of hydroxychloroquine has increased recently during the COVID-19 pandemic. These data demonstrating decreased risk of cardiovascular outcomes in systemic LE patients on hydroxychloroquine may help patients make an informed decision regarding their care.

– Margaret Hammond, MD

Abstract

BACKGROUND

Limited data suggest that hydroxychloroquine may affect risk of cardiovascular disease in patients with lupus erythematosus (LE).

OBJECTIVE

To investigate whether hydroxychloroquine treatment is associated with major adverse cardiovascular events (MACE) (myocardial infarction, ischemic stroke, or cardiovascular-associated death) in patients with cutaneous LE (CLE) or systemic LE (SLE).

METHODS

Based on the Danish nationwide registers, an observational cohort study was conducted including patients with first-time diagnosis of CLE or SLE (between 1997-2017). Cox regression models calculating hazard ratio (HR) analyzing the risk of MACE was performed comparing time on and off hydroxychloroquine (including never-user). The models were adjusted for age, sex, socio-economic status, concomitant treatment, and cardiovascular risk factors.

RESULTS

Among 4587 patients with LE, 51% (n=2343) were treated with HCQ during the study period. An inverse association between use of HCQ and MACE risk was observed among patients with SLE (adjusted HR 0.65; 95% CI 0.46-0.90) and patients with CLE (adjusted HR 0.71; 95% CI 0.42-1.19). Consistent results were found in sensitivity analyses including a case-time-control design.

LIMITATIONS

No information on disease activity/severity was available.

CONCLUSION

Our findings indicate an opportunity to reduce risk of cardiovascular events in patients with LE through use of hydroxychloroquine.

Journal of the American Academy of Dermatology

Use of Hydroxychloroquine and Risk of Major Adverse Cardiovascular Events in Patients With Lupus Erythematosus: A Danish Nationwide Cohort Study

J Am Acad Dermatol 2020 Dec 12;[EPub Ahead of Print], JH Haugaard, L Dreyer, MB Ottosen, G Gislason, K Kofoed, A Egeberg

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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