At the recent American College of Rheumatology meeting in Atlanta, researchers hypothesized that the use of hydroxychloroquine could reduce cardiovascular events in elderly patients with rheumatoid arthritis (RA).
In this exclusive 鶹ý video, , of Allegheny Health Network in Pittsburgh, and , of North Dakota State University in Fargo, discuss the findings.
Following is a transcript of their remarks:
Wasko: A very interesting study I was asked to discuss. This is a follow-up to previous work that has been done indicating that hydroxychloroquine actually can reduce the risk of thrombotic events in users. In the 1980s, this drug was used to prevent DVTs [deep vein thromboses] in orthopedic patients having surgery. More recently, this medication has been used extensively to treat lupus and rheumatoid arthritis. In the current study, the authors obtained the Medicare database and studied 1,602 patients with hydroxychloroquine use in rheumatoid arthritis and compared those patients with 3,204 comparator patients who were matched on various demographic characteristics using propensity scores.
The outcome of interest was major adverse coronary or cardiovascular events [MACE]. The hypothesis of this study was that hydroxychloroquine use would reduce the likelihood of those MACE events in these RA patients. The study did confirm that was, in fact, the case. The hazard of cardiovascular events in hydroxychloroquine users was 0.47, indicating about a 50% reduction in cardiovascular risk in the users compared to the non-users. They also looked at mortality and MACE events in these patients and found a similar outcome, indicating that not only is the risk of cardiovascular events reduced, but also overall death.
The significance of this study is actually relevant to the general population in that hydroxychloroquine is a generically available medication. Cardiovascular events are extremely common, particularly in elderly patients. This drug may very well have a role in preventing cardiovascular events in the general population. The drug doesn't require any medication monitoring -- excuse me, lab monitoring. It does require serial eye exams to check for retinal toxicity, but in general, it is a very safe, easy-to-use medication.
Miller: I think it's a fascinating study because hydroxychloroquine is a well-established drug, but a lot of people don't appreciate all of its properties. It's not only immune modulatory, but it reduces lipids and it affects glucose tolerance. It has antiplatelet effects, so it's actually fairly natural that it may have some effects on cardiovascular events.
This particular study was a retrospective cohort and looked at Medicare populations, so an elderly group, had a couple thousand patients in it. It matched patients who were taking hydroxychloroquine to patients who were very similar, but not taking hydroxychloroquine. The mean time of follow-up was over a year. They found that actually the patients who were taking hydroxychloroquine had a 50% lower risk of major adverse cardiovascular events, so pretty remarkable.
I think this was an observational study, so it doesn't prove hydroxychloroquine reduces events, but it really makes sense because of the properties of the drug that I talked about before. There has been previous work on this, too. There was a very similar retrospective cohort study that looked at the same thing and found about a 72% reduction in cardiovascular events. There was a study in lupus patients that showed reduced events, and there's actually now a randomized, controlled study going on called the , so I think that'll be fascinating to see if this turns out to be a real property of hydroxychloroquine.
Wasko: The authors alluded to the possibility that this medication may have a role in cardiovascular prophylaxis. In the general population, to propose such a clinical trial would be a costly endeavor and require large-scale funding to make that happen, much along the lines of the CIRT [Cardiovascular Inflammation Reduction Trial] that was carried out looking at methotrexate for such a use. Whether or not the NIH [National Institutes of Health] would provide such funding remains to be seen.