Hydroxychloroquine Reduces Risk of Cardiovascular Events in Rheumatoid Arthritis

The anti-arthritis drug hydroxychloroquine dramatically reduces the risk of cardiovascular morbidity and mortality in the disease, according to research presented here at the 2014 meeting of the American College of Rheumatology.

Treatment with hydroxychloroquine (HCQ) was associated with a dose-dependent reduction of cardiovascular events in over 200 patients taking the drug for rheumatoid arthritis (RA), compared to a similar group of patients who never received the drug, reported Michael Shapiro, MD, co-lead author of the study, from Meir medical Center in Kfar Sabra, Israel.

“Cardiovascular morbidity and mortality pose a substantial burden on thelives of our rheumatoid arthritis patients,” he said, “and we have limited tools to address this aspect of the disease.” Accelerated atherosclerosis and cardiovascular disease are two major causes of mortality in RA.

HCQ is an anti-malarial drug used in RA for its anti-inflammatory properties. Recently it was shown to reduce LDL cholesterol, reduce diabetes risk, and increase elasticity of atherosclerotic arteries.

To determine whether it provided direct benefits in cardiovascular risk in RA, the authors retrospectively compared drug treatment and CV outcomes in 241 patients who had received HCQ for an average of 5 years to 273 patients who had never received the drug, controlling for disease severity, CV risk factors, and other medications. Funding for the study was independent of the drug’s manufacturer.

Among those receiving HCQ, 13.3% experienced one or more cardiovascular events, versus 38.1% in those never receiving the drug (OR=0.271, 95% CI 0.159 to 0.462). “Hydroxychloroquine treatment had a significant protective effect for all cardiovascular events examined,” Dr. Shapiro said.

High-dose treatment (400 mg/day) was protective for myocardial infarction, stroke, transient ischemic attack, and venous events, while the only effect of low-dose treatment (200 mg/day) was seen on myocardial infarction.

“Rheumatoid arthritis patients have a two-fold increased risk of cardiovascular events compared to the general population, and thus prevention is of the utmost importance,” Shapiro said. “Our study provides novel evidence that hydroxychloroquine contributes to the prevention of cardiovascular morbidity among these patients. We believe that in clinical decision-making, hydroxychloroquine should be considered not only for its anti-inflammatory effect but also for the drug’s added preventive value.”