American College of Rheumatology White Paper on Antimalarial Cardiac Toxicity
American College of Rheumatology White Paper on Antimalarial Cardiac Toxicity
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DOI：
10.1002/art.41934
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发表时间：
2021-10-26
影响因子：
13.3
通讯作者：
Kovacs, Richard
中科院分区：
文献类型：
--
作者：
Desmarais, Julianna;Rosenbaum, James T.;Kovacs, Richard
羟基氯喹(HCQ)和氯喹(CQ)是公认的治疗系统性红斑狼疮和类风湿性关节炎以及皮肤疾病(如皮肤红斑狼疮)的药物。在极少数情况下，心律失常和传导系统异常，以及心肌病，已报告与HCQ/CQ的使用有关。然而，最近，这些药物的校正QT间期(QTC)延长的潜力，特别是尖端扭矩(Tdp)的风险，在它们用于新冠肺炎感染的实验中得到了强调。这份报告总结了目前对HCQ/CQ心脏毒性的认识，描述了QTC延长和TDP风险，并讨论了未来研究的优先领域。一个由风湿学、心脏病学和皮肤科专家组成的工作组进行了非系统的文献综述，并提供了基于共识的专家意见。目前的数据清楚地表明，HCQ和CQ在风湿和皮肤病的治疗中是非常有价值的药物，但它们通过直接影响心脏复极而与QTC延长有关。开处方的临床医生应该意识到这一微小的影响，特别是在服用额外药物延长QTC间期的患者中。长期使用HCQ/CQ可能会导致与心律失常和心力衰竭相关的心肌病。在开始任何药物治疗之前，应考虑风险和效益评估，关于HCQ/CQ的处方，初始和持续的风险-效益评估都很重要。虽然与HCQ/CQ治疗风湿性疾病有关的心脏毒性报道很少，但它可能是致命的。认识到HCQ和CQ对心脏的潜在不良影响可以增加这些药物的安全使用。显然有必要进行更多的研究，以便更好地了解风湿性和皮肤病治疗中使用的这些疗法的心血管风险和安全性。
Hydroxychloroquine (HCQ) and chloroquine (CQ) are well-established medications used in treating systemic lupus erythematosus and rheumatoid arthritis, as well as skin conditions such as cutaneous lupus erythematosus. In rare cases, arrhythmias and conduction system abnormalities, as well as cardiomyopathy, have been reported in association with HCQ/CQ use. Recently, however, the corrected QT interval (QTc)-prolonging potential of these medications, and risk of torsade de pointes (TdP) in particular, have been highlighted in the setting of their experimental use for COVID-19 infection. This report was undertaken to summarize the current understanding of HCQ/CQ cardiac toxicity, describe QTc prolongation and TdP risks, and discuss areas of priority for future research. A working group of experts across rheumatology, cardiology, and dermatology performed a nonsystematic literature review and offered a consensus-based expert opinion. Current data clearly indicate that HCQ and CQ are invaluable medications in the management of rheumatic and dermatologic diseases, but they are associated with QTc prolongation by directly affecting cardiac repolarization. Prescribing clinicians should be cognizant of this small effect, especially in patients taking additional medications that prolong the QTc interval. Long-term use of HCQ/CQ may lead to a cardiomyopathy associated with arrhythmias and heart failure. Risk and benefit assessment should be considered prior to initiation of any medication, and both initial and ongoing risk-benefit assessments are important with regard to prescription of HCQ/CQ. While cardiac toxicity related to HCQ/CQ treatment of rheumatic diseases is rarely reported, it can be fatal. Awareness of the potential adverse cardiac effects of HCQ and CQ can increase the safe use of these medications. There is a clear need for additional research to allow better understanding of the cardiovascular risk and safety profile of these therapies used in the management of rheumatic and cutaneous diseases.