Hydroxychloroquine Associated With Decreased Risk for Incident Atrial Fibrillation in Patients With SLE

Treatment with hydroxychloroquine is associated with a reduced risk for incident atrial fibrillation in patients with systemic lupus erythematosus (SLE), according to study results published in Arthritis Care & Research.

Previous studies indicated that hydroxychloroquine may have antiarrhythmic effects and cardiovascular benefits. However, there are limited data on the association between hydroxychloroquine and incident atrial fibrillation.

The objective of the current study was to determine the association between hydroxychloroquine use and new-onset atrial fibrillation in patients with SLE.

The primary endpoint was incident atrial fibrillation; secondary outcomes were incident ventricular arrhythmias, including ventricular tachycardia/fibrillation and torsades de pointes.

The retrospective study included 1647 adult patients (92% women; mean age, 53.6 years) with SLE from the Allegheny Health Network, a tertiary care academic center in western Pennsylvania, between December 2014 and May 2017. Of these patients, 917 received treatment with hydroxychloroquine and 730 were “nonusers of hydroxychloroquine.

A total of 23 incident atrial fibrillation events – 3 in the hydroxychloroquine-user group and 20 in the non-user group – were observed during a median follow-up duration of 566 days and 830 days, respectively (P =.32).

Logistic regression analysis indicated that treatment with hydroxychloroquine was associated with an 88% lower risk for incident atrial fibrillation (odds ratio [OR], 0.12; 95% CI, 0.034-0.39; P =.0005). The protective relationship with incident atrial fibrillation was sustained in the fully adjusted logistic regression model, after adjusting for demographics, comorbidities, and medications.

Researchers did not observe a significant association between hydroxychloroquine use and ventricular arrhythmias (OR, 2.39; 95% CI, 0.25-23.0; P =.45).

Results remained significant in the fully adjusted and propensity score-matched models.

The study had several limitations, including the observational design and lack of data on disease activity, disease duration, and duration and cumulative exposure of hydroxychloroquine.

“Given the relative safety and low cost of hydroxychloroquine, and its favorable antithrombotic and cardiovascular risk benefit, a broader investigation of hydroxychloroquine in other cohorts or randomized studies to confirm its antifibrillatory effect would be warranted,” the researchers concluded.

Reference

Gupta A, Shields KJ, Manzi S, Wasko MC, Sharma TS. Association of hydroxychloroquine use with decreased incident atrial fibrillation in systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2021;73(6):828-832. doi:10.1002/acr.24494