Background Cardiovascular disease (CVD) is the leading cause of mortality in rheumatoid arthritis (RA) patients (1). Hydroxychloroquine (HCQ) has been shown to improve major outcomes like survival rates in other inflammatory diseases, like systemic lupus (2).
Objectives The aim of our study was to assess currently available literature on the cardiovascular impact of hydroxychloroquine (HCQ) in patients with RA.
Methods We systematically searched literature (via Pubmed, Embase and abstracts from recent ACR and EULAR congresses) for studies evaluating the effects of HCQ, wether in monotherapy or in combination with other conventional synthetic disease modifying antirheumatic drugs (csDMARDs) on cardiovascular outcomes or known risk factors for CVD in RA patients (lipid profiles, diabetes incidence, insulin resistance and incidence of CVD). A meta-analysis was performed with Review Manager Software, with random effects models, whenever methodologically possible and relevant. Data were extracted by one investigator and independently checked by another.
Results The literature search revealed 185 articles and abstracts of potential interest, and further examination resulted in 16 studies fulfilling required criteria for preplanned analyses regarding the cardiovascular impact of HCQ in RA. For lipid profiles, the mean difference (mg/dL) between HCQ users versus nonusers was -9,82 (95% confidence interval [95% CI] 14.03$;$ 5.60) for total cholesterol, -10.61 [14.17$;$7.04] for low density lipoprotein, -19.15 [27.20$;$ 11.10] for triglycerides and +4.13 [2.22$;$6.04] for high density lipoprotein (figure 1)$;$ with respectively a decrease (mg/dL) of 13.15 [20.96$;$ 5.34], 12.35 [20.14$;$ 4.36], 12.54 [28.94$;$ 3.86] and an increase of 1.67 [0.96, 4.31] after HCQ initiation. Diabetes incidence was reduced in “HCQ ever users” versus “patients who never used HCQ” with a hazard ratio of 0.59 [0.49$;$ 0.70]. In addition, HCQ seems to decrease insulin resistance and incidence of cardiovascular events but data were too scarce for meta-analysis.
Conclusions Beside its limited efficacy on disease activity, this study supports the interest of HCQ on lipid profiles, and diabetes incidence, and to a lesser extent on cardio-vascular events and insulin resistance in RA patients. Therefore, this study suggests that HCQ may be of some interest in RA, in combination with other csDMARDS.
Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008 Dec 15;59(12):1690–7.
Petri M. Hydroxychloroquine use in the Baltimore Lupus Cohort: effects on lipids, glucose and thrombosis. Lupus. 1996 Jun;5 Suppl 1:S16–22.
Disclosure of Interest None declared