Use of hydroxychloroquine may be protective for cardiovascular events in patients with systemic lupus erythematosus 

1. In this observational cohort study of patients with systemic lupus erythematosus, the current use of hydroxychloroquine as a treatment was associated with a decreased risk of cardiovascular events. 

2. Compared to patients that stopped the use of hydroxychloroquine or never used it, patients currently undergoing treatment with hydroxychloroquine were statistically less likely to undergo a cardiovascular event. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Hydroxychloroquine has been proposed as a potential treatment option for systemic lupus erythematosus (SLE), an autoimmune disease which causes organ damage. Previous studies have found hydroxychloroquine treatment of patients with SLE resulted in reduced severity of the disease while treatment was continued, and a better overall survival rate compared to untreated patients. However, there is limited data on the protective effects of hydroxychloroquine for individual cardiovascular (CV) events. To address this gap, the study aimed to examine the link between hydroxychloroquine treatment and (CV) events. The CV events examined included myocardial infarction (MI), stroke, and other thromboembolic events (OTEs). The anonymous cohort study was done using pooled data from the National System of Health Databases (SNDS) in France between 2010 and 2020, and used a nested case-control design. Using incidence density sampling, up to 10 controls were used to match patients with a CV event to those who did not. In this cohort study of patients with SLE, there was an association between the use of hydroxychloroquine and reduced risk of myocardial infarction, stroke, OTEs, and the composite CV outcome. The study was limited by the observational nature which could have led to potential confounding. Despite this, the study results showed a protective relationship between current treatment with hydroxychloroquine in patients with SLE and CV events. 

Click here to read the study in JAMA Network Open

Relevant Reading: Hydroxychloroquine use and cardiovascular events among patients With systemic lupus erythematosus and rheumatoid arthritis 

In-Depth [cohort study]: In all, of the 52883 SLE patients, 1981 with a CV event were matched with 16892 in the control group. Among all SLE patients, 4210 experienced a CV event, with the majority occurring within 6 months of SLE diagnosis. Of the total SLE patients, 49597 (87.7%) were given hydroxychloroquine at least once in follow-up. Patients using hydroxychloroquine, compared to those who did not within the last year, were less likely to experience a CV event, both overall (aOR, 0.63; 95% CI, 0.57-0.70) and individually tracked events; MI (aOR, 0.72; 95% CI, 0.60-0.87), stroke (aOR, 0.71; 95% CI, 0.61-0.83), and OTE (aOR, 0.58; 95% CI, 0.48-0.69). Those who had remote treatment (between 91 and 365 days) showed no statistical differences in CV outcomes with those who had no exposure. Additional sensitivity analysis of patients who had a previous CV event showed a protective association of current hydroxychloroquine use (aOR, 0.64 [95% CI, 0.58-0.71]). A critical finding was that patients who stopped treatment between 91 and 365 days prior to a CV event did not show characteristic difference to those who continued treatment. With recent studies showing inflammation playing a key role in CV events, the effects of hydroxychloroquine remain unclear. Overall, the study showed that patients using hydroxychloroquine treatment for SLE had less likelihood for MI, stroke and OTE than patients who were not using, or had discontinued.

Image: PD

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