Hydroxychloroquine (HCQ) is a cornerstone therapy for systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, reports of its use and subsequent fatal arrhythmias in patients with coronavirus disease 19 (COVID-19) have raised concern regarding its cardiovascular (CV) safety. Therefore, we examined the relationship between HCQ use and corrected QT (QTc) length in SLE and RA patients without clinical CV disease (CVD). SLE patients from the Columbia University Lupus Cohort registry (n = 352) and two RA cohorts (n = 178; ESCAPE-RA and RHYTHM-RA) with electrocardiograms (ECGs) collected as part of study data were analyzed. RA cohort participants were recruited from tertiary referral centers with additional referrals from community rheumatologists, while SLE subjects originated from the Columbia University Lupus Cohort. All patients met American College of Rheumatology (ACR) classification criteria for SLE or RA and lacked known CVD. The exposure of interest was HCQ use and main outcome measure was QTc length [continuous or categorical (≥ 440 ms and ≥ 500 ms)]. Of the combined SLE and RA cohorts (n = 530), 70% were HCQ users and 44% had a QTc ≥ 440 ms. The adjusted mean QTc length was comparable between HCQ users vs non-users (438 ms vs 437 ms). In multivariable logistic models, HCQ use was not a significant predictor of a QTc ≥ 440 ms for the entire cohort (OR 0.77; 95% CI 0.48–1.23; p = 0.27). Importantly, a QTc ≥ 500 ms was inversely associated with HCQ use and not associated with arrhythmias or deaths. A significant interaction was found between HCQ use and use of anti-psychotics. Ultimately, the use of HCQ combined with any QTc prolonging medication as a group was associated with a QTc length (434 ms; 95% CI 430, 439) which was comparable to that of use of HCQ alone (433 ms; 95% CI 429-437). In a combined cohort of SLE and RA patients without clinical CVD, adjusted QTc length was comparable between HCQ and non-HCQ users, supporting its CV safety in patients with rheumatic diseases.

中文翻译：

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在一大群 SLE 和 RA 患者中，羟氯喹的使用与 QTc 长度无关

羟氯喹 (HCQ) 是治疗系统性红斑狼疮 (SLE) 和类风湿性关节炎 (RA) 的基石疗法。然而，有关其在冠状病毒病 19 (COVID-19) 患者中的使用和随后的致命性心律失常的报告引起了对其心血管 (CV) 安全性的担忧。因此，我们检查了无临床心血管疾病 (CVD) 的 SLE 和 RA 患者使用 HCQ 与校正 QT (QTc) 长度之间的关系。分析了来自哥伦比亚大学狼疮队列登记处（n = 352）和两个 RA 队列（n = 178；ESCAPE-RA 和 RHYTHM-RA）的 SLE 患者的心电图 (ECG) 作为研究数据的一部分。RA 队列参与者是从三级转诊中心招募的，另外还有社区风湿病学家的转诊，而 SLE 受试者则来自哥伦比亚大学狼疮队列。所有患者均符合美国风湿病学会 (ACR) 对 SLE 或 RA 的分类标准，并且没有已知的 CVD。感兴趣的暴露是使用 HCQ，主要结果测量是 QTc 长度 [连续或分类（≥ 440 ms 和 ≥ 500 ms）]。在合并的 SLE 和 RA 队列（n = 530）中，70% 是 HCQ 用户，44% 的 QTc ≥ 440 ms。HCQ 使用者与非使用者之间调整后的平均 QTc 长度相当（438 毫秒与 437 毫秒）。在多变量逻辑模型中，HCQ 的使用不是整个队列 QTc ≥ 440 ms 的重要预测因素（OR 0.77；95% CI 0.48–1.23；p = 0.27）。重要的是，QTc ≥ 500 ms 与 HCQ 的使用呈负相关，与心律失常或死亡无关。HCQ 的使用与抗精神病药物的使用之间存在显着的相互作用。最终，使用 HCQ 与任何 QTc 延长药物作为一个组与 QTc 长度（434 ms；95% CI 430, 439）相关，这与单独使用 HCQ（433 ms；95% CI 429-437）相当）。在没有临床 CVD 的 SLE 和 RA 患者的联合队列中，HCQ 和非 HCQ 使用者之间调整后的 QTc 长度具有可比性，支持其在风湿性疾病患者中的 CV 安全性。