Hydroxychloroquine may have metabolic benefits in patients with RA
medwireNews: Treatment with hydroxychloroquine (HCQ) is associated with an improved lipid profile and a reduction in the incidence of diabetes and cardiovascular disease among patients with rheumatoid arthritis (RA), researchers report.
In a systematic review and meta-analysis, Charlotte Hua (Montpellier University, France) and colleagues analyzed data from nine studies investigating the metabolic or cardiovascular impact of HCQ, two of which were randomized trials while seven were observational studies. A total of 12,245 patients who underwent HCQ treatment and 22,968 patients who did not were included in the study.
The team found that total cholesterol levels were a mean 9.8 mg/dL lower among patients who were treated with HCQ compared with HCQ non-users. Total cholesterol and triglyceride levels were also reduced among HCQ users, by 10.6 mg/dL and 19.1 mg/dL, respectively, whereas high-density lipoprotein cholesterol levels were increased by 4.1 mg/dL.
Moreover, in three studies investigating diabetes incidence, patients receiving HCQ treatment were a significant 41% less likely to have diabetes than those who had never received HCQ, and in one randomized trial comparing HCQ with methotrexate, glycated hemoglobin levels fell by a greater extent among participants in the HCQ group (0.19 vs 0.08%), indicating better glycemic control.
The results of three observational studies suggested that HCQ-treated patients had a lower risk for cardiovascular disease than non-HCQ users, with two studies reporting odds ratios of 0.27 and 0.45, and one reporting a hazard ratio of 0.60. However, the researchers caution that “data were too few for meta-analysis.”
Taken together, these findings suggest that “HCQ has a positive impact on metabolic and cardiovascular outcomes in patients with RA, both by decreasing modifiable factors for CVD, namely, lipid profile, diabetes incidence and glycosylated haemoglobin level, and by decreasing the incidence of cardiovascular events,” write Hua and colleagues in the Annals of the Rheumatic Diseases.
They note that although “HCQ has been used for treating RA for several decades,” it is not recommended as monotherapy given “the emergence of more efficient conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).”
However, the team recommends that because it is a well-tolerated and inexpensive drug, adding HCQ to other csDMARDs “may comprise a useful adjunct in the prevention of metabolic and cardiovascular events for patients with RA.”
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