Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus
To perform a comprehensive evaluation of heart rhythm disorders and the influence of disease/therapy factors in a large systemic lupus erythematosus (SLE) cohort. Three hundred and seventeen consecutive patients of an ongoing electronic database protocol were evaluated by resting electrocardiogram a...
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| Veröffentlicht in: | Europace (London, England) England), 2014-06, Vol.16 (6), p.887-892 |
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| creator | Teixeira, Ricardo Alkmim Borba, Eduardo F Pedrosa, Anísio Nishioka, Silvana Viana, Vilma S T Ramires, José A Kalil-Filho, Roberto Bonfá, Eloísa Martinelli Filho, Martino |
| description | To perform a comprehensive evaluation of heart rhythm disorders and the influence of disease/therapy factors in a large systemic lupus erythematosus (SLE) cohort.
Three hundred and seventeen consecutive patients of an ongoing electronic database protocol were evaluated by resting electrocardiogram and 142 were randomly selected for 24 h Holter monitoring for arrhythmia and conduction disturbances. The mean age was 40.2 ± 12.1 years and disease duration was 11.4 ± 8.1 years. Chloroquine (CQ) therapy was identified in 69.7% with a mean use of 8.5 ± 6.7 years. Electrocardiogram abnormalities were detected in 66 patients (20.8%): prolonged QTc/QTd (14.2%); bundle-branch block (2.5%); and atrioventricular block (AVB) (1.6%). Age was associated with AVB (P = 0.029) and prolonged QTc/QTd (P = 0.039) whereas anti-Ro/SS-A and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores were not (P > 0.05). Chloroquine was negatively associated with AVB (P = 0.01) as was its longer use (6.1 ± 6.9 vs. 1.0 ± 2.5 years, P = 0.018). Time of CQ use was related with the absence of AVB [odds ratio (OR) = 0.103; 95% confidence interval (CI) = 0.011-0.934, P = 0.043] in multiple logistic regression. Holter monitoring revealed abnormalities in 121 patients (85.2%): supraventricular ectopies (63.4%) and tachyarrhythmia (18.3%); ventricular ectopies (45.8%). Atrial tachycardia/fibrillation (AT/AF) were associated with shorter CQ duration (7.05 ± 7.99 vs. 3.63 ± 5.02 years, P = 0.043) with a trend to less CQ use (P = 0.054), and older age (P < 0.001). Predictors of AT/AF in multiple logistic regression were age (OR = 1.115; 95% CI = 1.059-1.174, P < 0.001) and anti-Ro/SS-A (OR = 0.172; 95% CI = 0.047-0.629, P = 0.008).
Chloroquine seems to play a protective role in the unexpected high rate of cardiac arrhythmias and conduction disturbances observed in SLE. Further studies are necessary to determine if this antiarrhythmic effect is due to the disease control or a direct effect of the drug. |
| doi_str_mv | 10.1093/europace/eut290 |
| format | Article |
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Three hundred and seventeen consecutive patients of an ongoing electronic database protocol were evaluated by resting electrocardiogram and 142 were randomly selected for 24 h Holter monitoring for arrhythmia and conduction disturbances. The mean age was 40.2 ± 12.1 years and disease duration was 11.4 ± 8.1 years. Chloroquine (CQ) therapy was identified in 69.7% with a mean use of 8.5 ± 6.7 years. Electrocardiogram abnormalities were detected in 66 patients (20.8%): prolonged QTc/QTd (14.2%); bundle-branch block (2.5%); and atrioventricular block (AVB) (1.6%). Age was associated with AVB (P = 0.029) and prolonged QTc/QTd (P = 0.039) whereas anti-Ro/SS-A and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores were not (P > 0.05). Chloroquine was negatively associated with AVB (P = 0.01) as was its longer use (6.1 ± 6.9 vs. 1.0 ± 2.5 years, P = 0.018). Time of CQ use was related with the absence of AVB [odds ratio (OR) = 0.103; 95% confidence interval (CI) = 0.011-0.934, P = 0.043] in multiple logistic regression. Holter monitoring revealed abnormalities in 121 patients (85.2%): supraventricular ectopies (63.4%) and tachyarrhythmia (18.3%); ventricular ectopies (45.8%). Atrial tachycardia/fibrillation (AT/AF) were associated with shorter CQ duration (7.05 ± 7.99 vs. 3.63 ± 5.02 years, P = 0.043) with a trend to less CQ use (P = 0.054), and older age (P < 0.001). Predictors of AT/AF in multiple logistic regression were age (OR = 1.115; 95% CI = 1.059-1.174, P < 0.001) and anti-Ro/SS-A (OR = 0.172; 95% CI = 0.047-0.629, P = 0.008).
Chloroquine seems to play a protective role in the unexpected high rate of cardiac arrhythmias and conduction disturbances observed in SLE. Further studies are necessary to determine if this antiarrhythmic effect is due to the disease control or a direct effect of the drug.</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/eut290</identifier><identifier>PMID: 24050965</identifier><language>eng</language><publisher>England</publisher><subject>Adult ; Anti-Arrhythmia Agents - therapeutic use ; Antirheumatic Agents - therapeutic use ; Arrhythmias, Cardiac - diagnosis ; Arrhythmias, Cardiac - epidemiology ; Arrhythmias, Cardiac - prevention & control ; Brazil - epidemiology ; Cardiotonic Agents - therapeutic use ; Causality ; Chloroquine - therapeutic use ; Comorbidity ; Electrocardiography - drug effects ; Electrocardiography - statistics & numerical data ; Feasibility Studies ; Female ; Humans ; Lupus Erythematosus, Systemic - diagnosis ; Lupus Erythematosus, Systemic - drug therapy ; Lupus Erythematosus, Systemic - epidemiology ; Male ; Off-Label Use ; Prevalence ; Retrospective Studies ; Risk Assessment ; Treatment Outcome</subject><ispartof>Europace (London, England), 2014-06, Vol.16 (6), p.887-892</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c338t-5caac8375ac538411d8d75620b60b178368b389e5bdfdf204ed6d88802cefd6e3</citedby><cites>FETCH-LOGICAL-c338t-5caac8375ac538411d8d75620b60b178368b389e5bdfdf204ed6d88802cefd6e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24050965$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Teixeira, Ricardo Alkmim</creatorcontrib><creatorcontrib>Borba, Eduardo F</creatorcontrib><creatorcontrib>Pedrosa, Anísio</creatorcontrib><creatorcontrib>Nishioka, Silvana</creatorcontrib><creatorcontrib>Viana, Vilma S T</creatorcontrib><creatorcontrib>Ramires, José A</creatorcontrib><creatorcontrib>Kalil-Filho, Roberto</creatorcontrib><creatorcontrib>Bonfá, Eloísa</creatorcontrib><creatorcontrib>Martinelli Filho, Martino</creatorcontrib><title>Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>To perform a comprehensive evaluation of heart rhythm disorders and the influence of disease/therapy factors in a large systemic lupus erythematosus (SLE) cohort.
Three hundred and seventeen consecutive patients of an ongoing electronic database protocol were evaluated by resting electrocardiogram and 142 were randomly selected for 24 h Holter monitoring for arrhythmia and conduction disturbances. The mean age was 40.2 ± 12.1 years and disease duration was 11.4 ± 8.1 years. Chloroquine (CQ) therapy was identified in 69.7% with a mean use of 8.5 ± 6.7 years. Electrocardiogram abnormalities were detected in 66 patients (20.8%): prolonged QTc/QTd (14.2%); bundle-branch block (2.5%); and atrioventricular block (AVB) (1.6%). Age was associated with AVB (P = 0.029) and prolonged QTc/QTd (P = 0.039) whereas anti-Ro/SS-A and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores were not (P > 0.05). Chloroquine was negatively associated with AVB (P = 0.01) as was its longer use (6.1 ± 6.9 vs. 1.0 ± 2.5 years, P = 0.018). Time of CQ use was related with the absence of AVB [odds ratio (OR) = 0.103; 95% confidence interval (CI) = 0.011-0.934, P = 0.043] in multiple logistic regression. Holter monitoring revealed abnormalities in 121 patients (85.2%): supraventricular ectopies (63.4%) and tachyarrhythmia (18.3%); ventricular ectopies (45.8%). Atrial tachycardia/fibrillation (AT/AF) were associated with shorter CQ duration (7.05 ± 7.99 vs. 3.63 ± 5.02 years, P = 0.043) with a trend to less CQ use (P = 0.054), and older age (P < 0.001). Predictors of AT/AF in multiple logistic regression were age (OR = 1.115; 95% CI = 1.059-1.174, P < 0.001) and anti-Ro/SS-A (OR = 0.172; 95% CI = 0.047-0.629, P = 0.008).
Chloroquine seems to play a protective role in the unexpected high rate of cardiac arrhythmias and conduction disturbances observed in SLE. Further studies are necessary to determine if this antiarrhythmic effect is due to the disease control or a direct effect of the drug.</description><subject>Adult</subject><subject>Anti-Arrhythmia Agents - therapeutic use</subject><subject>Antirheumatic Agents - therapeutic use</subject><subject>Arrhythmias, Cardiac - diagnosis</subject><subject>Arrhythmias, Cardiac - epidemiology</subject><subject>Arrhythmias, Cardiac - prevention & control</subject><subject>Brazil - epidemiology</subject><subject>Cardiotonic Agents - therapeutic use</subject><subject>Causality</subject><subject>Chloroquine - therapeutic use</subject><subject>Comorbidity</subject><subject>Electrocardiography - drug effects</subject><subject>Electrocardiography - statistics & numerical data</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Lupus Erythematosus, Systemic - diagnosis</subject><subject>Lupus Erythematosus, Systemic - drug therapy</subject><subject>Lupus Erythematosus, Systemic - epidemiology</subject><subject>Male</subject><subject>Off-Label Use</subject><subject>Prevalence</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Treatment Outcome</subject><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kM1LxDAQxYMorq6evUmOXurmo2mToyzrByx40XNJk6kbaZuapEL_e7vsrodhHsN7j-GH0B0lj5QovoIx-EEbmEViipyhKyo4yxhR7HzWRKlMUKYW6DrGb0JIyZS4RAuWE0FUIa7Q1-bXWegN4MYHbHSwThscdQNpwrq38ySnQ9hNadc5gwefYH9psW-w2bU--J_R9YBdj-MUE-xN7TiMEUOYM9Dp5OMYb9BFo9sIt8e9RJ_Pm4_1a7Z9f3lbP20zw7lMmTBaG8lLoY3gMqfUSluKgpG6IDUtJS9kzaUCUdvGNozkYAsrpSTMQGML4Ev0cOgd9o9BTFXnooG21T34MVZUMCVzVshytq4OVhN8jAGaagiu02GqKKn2dKsT3epAd07cH8vHugP77z_h5H_qFXuj</recordid><startdate>20140601</startdate><enddate>20140601</enddate><creator>Teixeira, Ricardo Alkmim</creator><creator>Borba, Eduardo F</creator><creator>Pedrosa, Anísio</creator><creator>Nishioka, Silvana</creator><creator>Viana, Vilma S T</creator><creator>Ramires, José A</creator><creator>Kalil-Filho, Roberto</creator><creator>Bonfá, Eloísa</creator><creator>Martinelli Filho, Martino</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140601</creationdate><title>Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus</title><author>Teixeira, Ricardo Alkmim ; Borba, Eduardo F ; Pedrosa, Anísio ; Nishioka, Silvana ; Viana, Vilma S T ; Ramires, José A ; Kalil-Filho, Roberto ; Bonfá, Eloísa ; Martinelli Filho, Martino</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c338t-5caac8375ac538411d8d75620b60b178368b389e5bdfdf204ed6d88802cefd6e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Anti-Arrhythmia Agents - therapeutic use</topic><topic>Antirheumatic Agents - therapeutic use</topic><topic>Arrhythmias, Cardiac - diagnosis</topic><topic>Arrhythmias, Cardiac - epidemiology</topic><topic>Arrhythmias, Cardiac - prevention & control</topic><topic>Brazil - epidemiology</topic><topic>Cardiotonic Agents - therapeutic use</topic><topic>Causality</topic><topic>Chloroquine - therapeutic use</topic><topic>Comorbidity</topic><topic>Electrocardiography - drug effects</topic><topic>Electrocardiography - statistics & numerical data</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Lupus Erythematosus, Systemic - diagnosis</topic><topic>Lupus Erythematosus, Systemic - drug therapy</topic><topic>Lupus Erythematosus, Systemic - epidemiology</topic><topic>Male</topic><topic>Off-Label Use</topic><topic>Prevalence</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Teixeira, Ricardo Alkmim</creatorcontrib><creatorcontrib>Borba, Eduardo F</creatorcontrib><creatorcontrib>Pedrosa, Anísio</creatorcontrib><creatorcontrib>Nishioka, Silvana</creatorcontrib><creatorcontrib>Viana, Vilma S T</creatorcontrib><creatorcontrib>Ramires, José A</creatorcontrib><creatorcontrib>Kalil-Filho, Roberto</creatorcontrib><creatorcontrib>Bonfá, Eloísa</creatorcontrib><creatorcontrib>Martinelli Filho, Martino</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Teixeira, Ricardo Alkmim</au><au>Borba, Eduardo F</au><au>Pedrosa, Anísio</au><au>Nishioka, Silvana</au><au>Viana, Vilma S T</au><au>Ramires, José A</au><au>Kalil-Filho, Roberto</au><au>Bonfá, Eloísa</au><au>Martinelli Filho, Martino</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2014-06-01</date><risdate>2014</risdate><volume>16</volume><issue>6</issue><spage>887</spage><epage>892</epage><pages>887-892</pages><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>To perform a comprehensive evaluation of heart rhythm disorders and the influence of disease/therapy factors in a large systemic lupus erythematosus (SLE) cohort.
Three hundred and seventeen consecutive patients of an ongoing electronic database protocol were evaluated by resting electrocardiogram and 142 were randomly selected for 24 h Holter monitoring for arrhythmia and conduction disturbances. The mean age was 40.2 ± 12.1 years and disease duration was 11.4 ± 8.1 years. Chloroquine (CQ) therapy was identified in 69.7% with a mean use of 8.5 ± 6.7 years. Electrocardiogram abnormalities were detected in 66 patients (20.8%): prolonged QTc/QTd (14.2%); bundle-branch block (2.5%); and atrioventricular block (AVB) (1.6%). Age was associated with AVB (P = 0.029) and prolonged QTc/QTd (P = 0.039) whereas anti-Ro/SS-A and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores were not (P > 0.05). Chloroquine was negatively associated with AVB (P = 0.01) as was its longer use (6.1 ± 6.9 vs. 1.0 ± 2.5 years, P = 0.018). Time of CQ use was related with the absence of AVB [odds ratio (OR) = 0.103; 95% confidence interval (CI) = 0.011-0.934, P = 0.043] in multiple logistic regression. Holter monitoring revealed abnormalities in 121 patients (85.2%): supraventricular ectopies (63.4%) and tachyarrhythmia (18.3%); ventricular ectopies (45.8%). Atrial tachycardia/fibrillation (AT/AF) were associated with shorter CQ duration (7.05 ± 7.99 vs. 3.63 ± 5.02 years, P = 0.043) with a trend to less CQ use (P = 0.054), and older age (P < 0.001). Predictors of AT/AF in multiple logistic regression were age (OR = 1.115; 95% CI = 1.059-1.174, P < 0.001) and anti-Ro/SS-A (OR = 0.172; 95% CI = 0.047-0.629, P = 0.008).
Chloroquine seems to play a protective role in the unexpected high rate of cardiac arrhythmias and conduction disturbances observed in SLE. Further studies are necessary to determine if this antiarrhythmic effect is due to the disease control or a direct effect of the drug.</abstract><cop>England</cop><pmid>24050965</pmid><doi>10.1093/europace/eut290</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Europace (London, England), 2014-06, Vol.16 (6), p.887-892 |
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| source | Oxford Journals Open Access Collection; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Adult Anti-Arrhythmia Agents - therapeutic use Antirheumatic Agents - therapeutic use Arrhythmias, Cardiac - diagnosis Arrhythmias, Cardiac - epidemiology Arrhythmias, Cardiac - prevention & control Brazil - epidemiology Cardiotonic Agents - therapeutic use Causality Chloroquine - therapeutic use Comorbidity Electrocardiography - drug effects Electrocardiography - statistics & numerical data Feasibility Studies Female Humans Lupus Erythematosus, Systemic - diagnosis Lupus Erythematosus, Systemic - drug therapy Lupus Erythematosus, Systemic - epidemiology Male Off-Label Use Prevalence Retrospective Studies Risk Assessment Treatment Outcome |
| title | Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus |
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