POS0703 CARDIAC ADVERSE EFFECTS OF LONG-TERM USE OF HYDROXYCHLOROQUINE IN SYSTEMIC LUPUS ERYTHEMATOSUS. SINGLE UNIVERSITY CENTER STUDY OF 109 PATIENTS
Authors: A. Herrero-Morant, A. Margarida-de Castro, R. Pérez-Barquín, J. Zubiaur-Zamacola, M. Á. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2021)

Background: Hydroxychloroquine (HCQ) is a widely used drug especially in connective tissue disorders such as Systemic Lupus Erythematosus (SLE). Cardiac adverse effects of long-term use of HCQ remains controversial. Objectives: To assess cardiac adverse effects of long-term use of HCQ in SLE. Methods: Observational single center study of 109 patients with SLE treated with HCQ for more than 3 months. The main outcomes were cardiac structural and conduction disorders in a 12-lead electrocardiogram and/or echocardiogram at baseline and during HCQ treatment. Results: We studied 109 patients (95 women/14 men; mean age 66.9±14.7 years). Main cardiovascular history was hypertension (n=61, 56.0%), diabetes mellitus (n=16, 14.7%) and renal impairment (n=11, 10.1%). HCQ was used for 11.7±8.9 years. Initial median SLE Disease Activity Index 2000 (SLEDAI-2K) was 7 [3.75-11]. At baseline, 27 (24.8%) patients had conduction disorders and 15 (13.7%) had structural abnormalities: Most prevalent cardiac alterations were Left Anterior Fascicular Block (LAFB) (n=9, 8.3%), left ventricular hypertrophy (n=9, 8.3%) and right bundle branch block (n=8, 7.3%). After 11.7±8.9 years of follow-up (mean HCQ cumulative dose: 1042.2±267.5 g; median SLEDAI-2K 1 [0-4]), there was a significant increase in conductions disorders (n=41, 37.6%, p=0.011) and in LAFB (n=16, 14.7%, p=0.021). There was no statistically significant increase in structural abnormalities (n=21, 19.7%, p=0.629). Main cardiac abnormalities at baseline and after 11.7±8.9 years of follow-up are summarized in Table 1. Time of occurrence of cardiac adverse effect in relation to HCQ cumulative dose is shown in Figure 1. Table 1. Main cardiac abnormalities at baseline and after follow-up. Baseline After follow-up p Conduction disorders, n (%) 27 (24.8) 41 (37.6) 0.011 Left anterior fascicular block 9 (8.3) 16 (14.7) 0.021 Right bundle branch block 7 (6.4) 8 (7.3) 1.0 Atrioventricular block 4 (3.6) 11 (10.1) 0.092 Incomplete right bundle branch block 4 (3.6) 5 (4.6) 1.0 Short PR interval 2 (1.8) 4 (3.7) 0.5 Prolonged QT corrected interval 2 (1.8) 4 (3.7) 0.625 Left bundle branch block 1 (0.9) 5 (4.6) 0.125 Atrial Fibrillation 1 (0.9) 5 (4.6) 0.219 Structural abnormalities, n (%) 15 (13.7) 21 (19.7) 0.629 Ventricular hypertrophy 9 (8.3) 9 (8.3) 1.0 Atrial enlargement 6 (5.5) 13 (11.9) 0.096 Figure 1. Time of occurrence of cardiac adverse effect in relation to hydroxychloroquine cumulative dose. Conclusion: Conduction disorders were more prevalent than structural abnormalities. Patients with SLE treated with HCQ had a significant increase in LAFB. Use of electrocardiogram and/or echocardiogram may be helpful in monitoring cardiac adverse effects. Disclosure of Interests: Alba Herrero-Morant: None declared, Adrián Margarida-de Castro: None declared, Raquel Pérez-Barquín: None declared, Jon Zubiaur-Zamacola: None declared, Miguel Á. González-Gay Speakers bureau: AbbVie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: AbbVie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, Sanofi, Lilly and MSD, Grant/research support from: AbbVie, MSD, and Roche