Which is safer for heart of RA patients-hydroxychloroquine vs methotrexate?
USA: The use of hydroxychloroquine versus methotrexate in older patients with rheumatoid arthritis led to a similar risk of sudden cardiac arrest or ventricular arrhythmia (SCA/VA) and major adverse cardiovascular events (MACE), a recent study has shown.
The study, published in the Journal of the American College of Cardiology, further showed that initiation of hydroxychloroquine in patients with a history of heart failure (HF) had a higher risk of myocardial infarction, MACE, and all-cause mortality. Also, the researchers observed an increased risk of HF hospitalization among hydroxychloroquine initiators regardless of an HF history.
Hydroxychloroquine is used often as a first-line treatment of rheumatoid arthritis despite less evidence of its cardiovascular risk. Considering this, Elvira D'Andrea, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA, and colleagues aimed to conduct the evaluation of cardiovascular safety by comparing hydroxychloroquine to methotrexate among rheumatoid arthritis patients.
For this purpose, the researchers identified 54,462 propensity score-matched patients with rheumatoid arthritis, aged ≥65 years, who initiated hydroxychloroquine or methotrexate using Medicare data (2008-2016).
Sudden cardiac arrest or ventricular arrhythmia and MACE were the primary outcomes. Secondary outcomes included all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and hospitalized heart failure (HF). Treatment effects modification by a history of HF was also examined.
Based on the study, the researchers found the following:
- Hydroxychloroquine was not associated with the risk of SCA/VA (HR: 1.03) or MACE (HR: 1.07) compared with methotrexate.
- In patients with a history of HF, hydroxychloroquine initiators had a higher risk of cardiovascular mortality (HR: 1.34), MACE (HR: 1.30), all-cause mortality (HR: 1.22), myocardial infarction (HR: 1.74), and hospitalized HF (HR: 1.29) compared to methotrexate initiators.
- Cardiovascular risks were not different in patients without a history of HF except for an increased hospitalized HF risk (HR: 1.57) among hydroxychloroquine initiators.
"Hydroxychloroquine and methotrexate showed similar SCA/VA and MACE risks in older patients with rheumatoid arthritis; however, hydroxychloroquine initiators with a history of HF had higher risks of cardiovascular mortality, MACE, myocardial infarction, and all-cause mortality," the researchers wrote in their study. "An increased hospitalized HF risk was seen among hydroxychloroquine initiators regardless of an HF history."
Reference:
D'Andrea E, Desai RJ, He M, Glynn RJ, Lee H, Weinblatt ME, Kim SC. Cardiovascular Risks of Hydroxychloroquine vs Methotrexate in Patients With Rheumatoid Arthritis. J Am Coll Cardiol. 2022 Jul 5;80(1):36-46. doi: 10.1016/j.jacc.2022.04.039. PMID: 35772915.
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