American College of Rheumatology Report Summarizes Cardiac Toxicity Risks With Antimalarial Treatment - Rheumatology Advisor

The American College of Rheumatology (ACR) summarized a report regarding the cardiac toxicity associated with the long-term use of antimalarial drugs, including hydroxychloroquine (HCQ) and chloroquine (CQ). The full paper was published in Arthritis & Rheumatology.

Although HCQ and CQ are well-established therapies for systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and other rheumatic and dermatologic diseases, their experimental use in the treatment of COVID-19 has led to concerns about potential toxicities. In particular, the associated risks for corrected QT interval (QTc)-prolongation and torsade de pointes (TdP) have been highlighted.

To address these concerns and summarize the current understanding of HCQ/CQ, a working group of medical practitioners developed consensus-based opinions and recommendations. The working group included 8 rheumatologists, 2 dermatologists, and 2 expert electrophysiology cardiologists. The committee participated in 2 virtual conferences and reviewed published studies on HCQ/CQ and cardiac toxicity.


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The resulting report included the following primary components: a summary of QTc prolongation and TdP; a summary of independent risk factors for QTc prolongation; evidence for QTC prolongation with HCQ/CQ use; evidence for cardiac deposition disease with long-term HCQ/CQ use; suggestions for treating physicians; and directions for future research.

Summary of QTc Prolongation and TdP

Independent Risk Factors for QTc Prolongation

QTc Prolongation With HCQ/CQ Use

Cardiomyopathy With HCQ/CQ Use

Suggestions for Treating Physicians

Directions for Future Research

Conclusions

Both HCQ and CQ are important therapeutic options in the management of SLE and RA, as these drugs are known to substantially reduce disease activity. Cardiac toxicity, as a result of HCQ/CQ use, is rare, though the risk increases with prolonged exposure. A careful risk/benefit analysis should be conducted by providers prior to HCQ/CQ use. Further, consistent ECG monitoring is recommended if the patient has other risk factors for cardiac events.

“Increased clinical awareness of the potential for cardiac toxicity, both pro-arrhythmic

and associated with long-term use, is essential as HCQ and CQ remain foundational medications in the treatment of autoimmune rheumatic diseases, and their proven benefits should be weighed along with these risks,” the group noted.

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 

Reference

Desmarais J, Rosenbaum JT, Costenbader KH, et al. American College of Rheumatology white paper on antimalarial cardiac toxicity. Arthritis Rheumatol. Published online October 26, 2021. doi:10.1002/art.41934

https://www.rheumatologyadvisor.com/home/general-rheumatology/acr-report-white-paper-cardiac-toxicity-risks-with-antimalarial-treatment-hcq-cq/