Cardiovascular Risks of Hydroxychloroquine vs Methotrexate in Patients With Rheumatoid Arthritis.
Cardiovascular Risks of Hydroxychloroquine vs Methotrexate in Patients With Rheumatoid Arthritis.
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DOI：
10.1016/j.jacc.2022.04.039
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发表时间：
2022-07-05
影响因子：
24
通讯作者：
Kim, Seoyoung C.
中科院分区：
文献类型：
--
作者：
D'Andrea, Elvira;Desai, Rishi J.;He, Mengdong;Glynn, Robert J.;Lee, Hemin;Weinblatt, Michael E.;Kim, Seoyoung C.
关键词：
尽管关于其心血管风险的证据有限，但羟氯喹经常被用作类风湿关节炎的一线治疗方法。我们对类风湿性关节炎患者进行了心血管安全性评估，比较了羟氯喹和甲氨蝶呤。利用 Medicare 数据（2008-2016），我们确定了 54,462 名倾向评分匹配的类风湿性关节炎患者，年龄≥ 65 岁，开始使用羟氯喹或甲氨蝶呤。主要结局是心脏骤停或室性心律失常（SCA/VA）和主要不良心血管事件（MACE）。次要结局是心血管死亡率、全因死亡率、心肌梗塞、中风和住院心力衰竭（HF）。我们还检查了心力衰竭病史对治疗效果的影响。与甲氨蝶呤相比，羟氯喹与 SCA/VA（HR 1.03，95% CI 0.79–1.35）或 MACE（HR 1.07，95% CI 0.97–1.18）风险无关。在有心力衰竭病史的患者中，羟氯喹起始药物的 MACE 风险较高（HR 1.30，95% CI 1.08–1.56）、心血管死亡率（HR 1.34，95% CI 1.06–1.70）、全因死亡率（HR 1.22，95% CI 1.04–1.43）、心肌梗死（HR 1.74，95% CI 1.04–1.43）。 95% CI 1.25–2.42) 和住院心力衰竭 (HR 1.29, 95% CI 1.07–1.54) 甲氨蝶呤起始药物。除了羟氯喹起始药物中住院心力衰竭风险增加（HR 1.57，95% CI 1.30-1.90）外，无心力衰竭病史的患者的心血管风险没有差异。在老年类风湿性关节炎患者中，羟氯喹和甲氨蝶呤显示出相似的 SCA/VA 和 MACE 风险。然而，有心力衰竭病史的羟氯喹起始药物发生 MACE、心血管死亡、全因死亡和心肌梗死的风险较高。无论是否有心力衰竭病史，羟氯喹起始者中观察到住院心力衰竭风险增加。尽管有关其心血管风险的证据有限，但羟氯喹几十年来一直被用作类风湿性关节炎的一线治疗药物。我们利用 Medicare 按次付费进行了一项主动比较新用户队列研究，在 54,462 名老年类风湿性关节炎患者中评估羟氯喹与甲氨蝶呤相比的心血管安全性。与甲氨蝶呤相比，羟氯喹不会导致 SCA/VA 或 MACE 风险过高。然而，在有心力衰竭病史的个体中，羟氯喹似乎会增加 MACE、心血管死亡率、全因死亡率和心肌梗死的风险。无论心力衰竭病史如何，羟氯喹起始者中观察到住院心力衰竭的风险增加。
Hydroxychloroquine is often used as a first-line treatment of rheumatoid arthritis despite limited evidence on its cardiovascular risk. We conducted a cardiovascular safety evaluation comparing hydroxychloroquine to methotrexate among patients with rheumatoid arthritis. Using Medicare data (2008–2016), we identified 54,462 propensity score-matched patients with rheumatoid arthritis, aged ≥ 65 years, who initiated hydroxychloroquine or methotrexate. Primary outcomes were sudden cardiac arrest or ventricular arrythmia (SCA/VA), and major adverse cardiovascular event (MACE). Secondary outcomes were cardiovascular mortality, all-cause mortality, myocardial infarction, stroke, and hospitalized heart failure (HF). We also examined treatment effect modification by history of HF. Hydroxychloroquine was not associated with risk of SCA/VA (HR 1.03, 95% CI 0.79–1.35) or MACE (HR 1.07, 95% CI 0.97–1.18) compared to methotrexate. In patients with history of HF, hydroxychloroquine initiators had a higher risk of MACE (HR 1.30, 95% CI 1.08–1.56), cardiovascular mortality (HR 1.34, 95% CI 1.06–1.70), all-cause mortality (HR 1.22, 95% CI 1.04–1.43), myocardial infarction (HR 1.74, 95% CI 1.25–2.42), and hospitalized HF (HR 1.29, 95% CI 1.07–1.54) methotrexate initiators. Cardiovascular risks were not different in patients without history of HF except for an increased hospitalized HF risk (HR 1.57, 95% CI 1.30–1.90) among hydroxychloroquine initiators. In older patients with rheumatoid arthritis, hydroxychloroquine and methotrexate showed similar SCA/VA and MACE risks. However, hydroxychloroquine initiators with history of HF had higher risks of MACE, cardiovascular mortality, all-cause mortality, and myocardial infarction. An increased hospitalized HF risk was observed among hydroxychloroquine initiators regardless of a HF history. Hydroxychloroquine has been used as a first-line treatment of rheumatoid arthritis for decades despite limited evidence on its cardiovascular risk. We conducted an active comparator, new user cohort study using Medicare fee-for-service to evaluate the cardiovascular safety of hydroxychloroquine compared to methotrexate among 54,462 older patients with rheumatoid arthritis. Hydroxychloroquine did not confer excess in SCA/VA or MACE risks compared to methotrexate. However, among individuals with history of HF, hydroxychloroquine appears to increase the risks of MACE, cardiovascular mortality, all-cause mortality, and myocardial infarction. An increased risk of hospitalized HF was observed among hydroxychloroquine initiators regardless of HF history.
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DOI：
10.1056/nejmoa1809798
发表时间：
2019-02-21
期刊：
The New England journal of medicine
影响因子：
--
作者：
Ridker PM;Everett BM;Pradhan A;MacFadyen JG;Solomon DH;Zaharris E;Mam V;Hasan A;Rosenberg Y;Iturriaga E;Gupta M;Tsigoulis M;Verma S;Clearfield M;Libby P;Goldhaber SZ;Seagle R;Ofori C;Saklayen M;Butman S;Singh N;Le May M;Bertrand O;Johnston J;Paynter NP;Glynn RJ;CIRT Investigators
通讯作者：
CIRT Investigators
影响因子：
4.9
作者：
Jin, Yinzhu;Desai, Rishi J.;Kim, Seoyoung C.
通讯作者：
Kim, Seoyoung C.
影响因子：
5.4
作者：
Olubowale, Olusola Tope;Safford, Monika M.;Levitan, Emily B.
通讯作者：
Levitan, Emily B.
DOI：
10.1093/gerona/glx229
发表时间：
2018-07-01
影响因子：
5.1
作者：
Kim, Dae Hyun;Schneeweiss, Sebastian;Avorn, Jerry
通讯作者：
Avorn, Jerry
影响因子：
13.3
作者：
Desmarais, Julianna;Rosenbaum, James T.;Kovacs, Richard
通讯作者：
Kovacs, Richard