The impact of age and drug-drug interactions on qt interval in chronic hydroxychloroquine users in Arthritis and Rheumatology
2021
AOU Città della Salute di Torino
Tipo pubblicazione
Conference Abstract
Autori/Collaboratori (7)Vedi tutti...
Antivalle MG
Nuclear Medicine Unit, Department of Medical Sciences, University of Turin, Turin, Italy
Agosti M
L. Sacco University Hospital, Milano, Italy
La Paglia G
L.Sacco University Hospital, Milano, Lombardia, Italy
et alii...
Abstract
Background/Purpose: Hydroxychloroquine (HCQ) has been used safely for over 60 years in rheumatic patients. However, following its recent use in COVID-19 disease, its safety has been questioned, following controversial reports of cardiac toxicity, possibly related to a prolongation of the QT interval. Furthermore, it was recently shown that concomitant administration of different drugs can affect QT interval in hydroxychloroquine chronic users. Methods: 12-lead electrocardiograms were recorded in 355 ambulatory patients (SLE = 85, RA = 80, SSc = 71, UCTD = 68, other CTDs = 51). The analysis was performed on corrected QT intervals (QTc) calculated according to Framingham formula (QTc = QT+0.154 (1-RR)), with ULN = 449 ms in males, and 467 ms in females. Glomerular filtrate rate (eGFR) was calculated with the CKD-EPI equation. The influence on QTc values of demographic variables, chronic (?3 months) HCQ treatment, and of the use of 23 comedications -including corticosteroids, immunosuppressants, biologics, statins, aspirin, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, diuretics, betablockers, endothelin antagonists, duloxetine, selective serotonin reuptake inhibitors, gabapentinoids, proton-pump inhibitors (PPI), calcium channel blockers (CCBs) -were evaluated by parametric or non parametric statistical methods, as appropriate. All statistic analyses were performed with the IBM SPSS statistical package version 25. Results: Demographic variables, and the use of comedications were not different in HCQ+ and HCQ-patients (Table 1). In the whole population, the QTc mean duration was 416.44 ± 19.53 ms, and was correlated with age (Fig. 1; r = 0.211, p < 0.001), but not with gender (F: 417.79±19.02 ms, M: 413.21±23.73 ms, p = 0.303), eGFR (r = -0.83, p = 0.120), BMI (-0.001, p = 0.984) or disease (p = 0.139). In only 4 patients (HCQ+: 3 (1.5%) -HCQ-: 1 (0.6%), p = 0.629) QTc duration was above ULN. The patients were heavily cotreated, w
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DOI : 10.1002/art.41966
Keywords
acetylsalicylic acid; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; biological product; calcium channel blocking agent; corticosteroid; dipeptidyl carboxypeptidase inhibitor; diuretic agent; duloxetine; endothelin receptor antagonist; hydroxychloroquine; hydroxymethylglutaryl coenzyme A reductase inhibitor; immunosuppressive agent; proton pump inhibitor; serotonin uptake inhibitor; vitamin D; additive effect; adult; age; analysis of covariance; body mass; conference abstract; controlled study; demography; drug combination; drug competition; drug therapy; electrocardiogram; electrocardiography; estimated glomerular filtration rate; female; gender; human; major clinical study; male; QT interval; QT prolongation; QTc interval; undifferentiated connective tissue disease; univariate analysis;