Hydroxychloroquine and Chloroquine-Induced Cardiac Arrhythmias and Sudden Cardiac Death in Patients With Systemic Autoimmune Rheumatic Diseases: A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 38922589 · doi:10.1097/FJC.0000000000001589
What was done
A systematic review and meta-analysis searched MEDLINE and Embase through April 2023 for studies evaluating cardiac conduction abnormalities and arrhythmias in patients with systemic autoimmune rheumatic diseases (including systemic lupus erythematosus and rheumatoid arthritis) treated with hydroxychloroquine (HCQ) or chloroquine (CQ) compared to non-users. Meta-analysis was performed to assess differences in mean corrected QT (QTc) interval and odds ratios (OR) of prolonged QTc.
What was found
Across 34 included studies (70,609 total participants; 33 reporting on HCQ and 9 on CQ), 11 studies provided data for meta-analysis, all assessing HCQ. When pooling rheumatic diseases, HCQ users had significantly higher odds of prolonged QTc compared with non-users (odds ratio 1.57, 95% CI, 1.19 to 2.08). For rheumatoid arthritis specifically, the abstract reported a mean QTc increase of 10.29 ms (P = 0.458), while no difference in mean QTc was found between HCQ users and non-users in other rheumatic conditions.
Why it matters
This review quantifies the risk of cardiac conduction abnormalities associated with hydroxychloroquine in rheumatic diseases, providing evidence to support clinical vigilance and QTc monitoring in at-risk patients.
Limits
The abstract reports an internal discrepancy regarding rheumatoid arthritis QTc change (described as significant despite P = 0.458). Quantitative meta-analysis was limited to 11 of the 34 identified studies and restricted entirely to HCQ, precluding quantitative pooling for chloroquine. Details on dosing, therapy duration, baseline comorbidities, and concurrent QT-prolonging medications were not available in the abstract.
Cited by
- supports Hydroxychloroquine can cause cardiac rhythm disorders as well as permanent, irreversible visual changes.