QTc Prolongation with the Use of Hydroxychloroquine and Concomitant Arrhythmogenic Medications: A Retrospective Study Using Electronic Health Records Data.
QTc Prolongation with the Use of Hydroxychloroquine and Concomitant Arrhythmogenic Medications: A Retrospective Study Using Electronic Health Records Data.
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DOI：
10.1007/s40801-022-00307-5
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发表时间：
2022-09
影响因子：
2
通讯作者：
Malone, Daniel C
中科院分区：
文献类型：
--
作者：
Villa Zapata, Lorenzo;Boyce, Richard D;Chou, Eric;Hansten, Philip D;Horn, John R;Gephart, Sheila M;Subbian, Vignesh;Romero, Andrew;Malone, Daniel C
羟氯喹可引起某些患者的QT/QTc间期延长;然而，其与其他QT延长药物的相互作用知之甚少。这项回顾性电子健康记录研究的目的是评价服用羟氯喹伴或不伴QT延长药物的患者的QTc间期变化。从Cerner Health Facts®数据库获得去识别健康记录。关注的变量包括人口统计学、诊断、临床程序、实验室检查和药物。根据羟氯喹、甲氨蝶呤或柳氮磺胺吡啶单药或任何这些药物与任何已知可延长QT间期的合并药物的联合用药暴露，将患者分为6个队列。计算每个患者队列的Tisdale QTc风险评分。使用双样本配对t检验检验各组内QTc测量前后平均值之间的差异，使用ANOVA检验队列平均值之间的显著差异。在羟氯喹单药治疗队列中，发现QTc间期较伴随暴露前末次测量值统计学显著增加18.0 ms（95% CI 3.5-32.5; p < 0.05）。不同队列的QTc变化差异很大，标准差范围为40.9（羟氯喹单药治疗）至57.8（羟氯喹+柳氮磺胺吡啶）。队列间QTc测量值无差异。羟氯喹+QTc延长剂队列的平均Tisdale风险评分高于未合并暴露的队列（p < 0.05）。我们对回顾性电子健康记录的分析发现，与柳氮磺胺吡啶或甲氨蝶呤相比，羟氯喹与QTc间期中度延长相关。然而，伴随暴露于已知可延长QTc间期的其他药物时，QTc并未显著延长。
Hydroxychloroquine can induce QT/QTc interval prolongation for some patients; however, little is known about its interactions with other QT-prolonging drugs. The purpose of this retrospective electronic health records study was to evaluate changes in the QTc interval in patients taking hydroxychloroquine with or without concomitant QT-prolonging medications. De-identified health records were obtained from the Cerner Health Facts® database. Variables of interest included demographics, diagnoses, clinical procedures, laboratory tests, and medications. Patients were categorized into six cohorts based on exposure to hydroxychloroquine, methotrexate, or sulfasalazine alone, or the combination of any those drugs with any concomitant drug known to prolong the QT interval. Tisdale QTc risk score was calculated for each patient cohort. Two-sample paired t-tests were used to test differences between the mean before and after QTc measurements within each group and ANOVA was used to test for significant differences across the cohort means. A statistically significant increase in QTc interval from the last measurement prior to concomitant exposure of 18.0 ms (95% CI 3.5–32.5; p < 0.05) was found in the hydroxychloroquine monotherapy cohort. QTc changes varied considerably across cohorts, with standard deviations ranging from 40.9 (hydroxychloroquine monotherapy) to 57.8 (hydroxychloroquine + sulfasalazine). There was no difference in QTc measurements among cohorts. The hydroxychloroquine + QTc-prolonging agent cohort had the highest average Tisdale Risk Score compared with those without concomitant exposure (p < 0.05). Our analysis of retrospective electronic health records found hydroxychloroquine to be associated with a moderate increase in the QTc interval compared with sulfasalazine or methotrexate. However, the QTc was not significantly increased with concomitant exposure to other drugs known to increase QTc interval.