1
|
Nikolic RPA, Virk MK, Buhler KA, Costenbader KH, Choi MY, Weber BN. Hydroxychloroquine and Chloroquine-Induced Cardiac Arrhythmias and Sudden Cardiac Death in Patients With Systemic Autoimmune Rheumatic Diseases: A Systematic Review and Meta-Analysis. J Cardiovasc Pharmacol 2024; 84:158-169. [PMID: 38922589 DOI: 10.1097/fjc.0000000000001589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/10/2024] [Indexed: 06/27/2024]
Abstract
ABSTRACT Hydroxychloroquine (HCQ) and chloroquine (CQ) are foundational treatments for several systemic autoimmune rheumatic diseases, including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Concerns regarding the risk of cardiac arrhythmia and death have been raised, yet the burden of HCQ and CQ-related cardiac toxicities remains unclear. A systematic literature search was conducted in the MEDLINE and Embase databases for articles published between the earliest date and April 2023 reporting cardiac conduction abnormalities in patients with systemic autoimmune rheumatic diseases taking HCQ or CQ. Meta-analysis was performed to calculate the difference in mean corrected QT (QTc) interval and odds ratio of prolonged QTc interval in those taking HCQ or CQ versus not. Of 2673 unique records, 34 met the inclusion criteria, including 70,609 subjects. Thirty-three studies reported outcomes in HCQ and 9 in CQ. Five studies reported outcomes in RA, 11 in SLE, and 18 in populations with mixed rheumatic diseases. Eleven studies reported mean QTc and OR for prolonged QTc for meta-analysis, all reporting outcomes in HCQ. There was a significant increase in mean QTc (10.29 ms, P = 0.458) among HCQ users compared to non-HCQ users in patients with RA. There was no difference in mean QTc between HCQ and non-HCQ users in other systemic autoimmune rheumatic diseases. When rheumatic diseases were pooled, HCQ users were more likely to have prolonged QTc compared to non-HCQ users (odds ratio 1.57, 95% CI, 1.19, 2.08). The results of this study suggest that clinicians should be aware of potential adverse cardiac events of HCQ and consider QTc monitoring for patients on HCQ for the treatment of systemic autoimmune rheumatic diseases.
Collapse
MESH Headings
- Hydroxychloroquine/adverse effects
- Humans
- Antirheumatic Agents/adverse effects
- Arrhythmias, Cardiac/chemically induced
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Chloroquine/adverse effects
- Rheumatic Diseases/drug therapy
- Rheumatic Diseases/mortality
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Autoimmune Diseases/chemically induced
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/mortality
- Autoimmune Diseases/drug therapy
- Risk Assessment
- Male
- Female
- Middle Aged
- Adult
- Risk Factors
- Cardiotoxicity
- Aged
- Heart Rate/drug effects
- Young Adult
- Treatment Outcome
- Action Potentials/drug effects
- Adolescent
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/mortality
Collapse
Affiliation(s)
- Roko P A Nikolic
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mansimran K Virk
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Katherine A Buhler
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - May Y Choi
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada ; and
| | - Brittany N Weber
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
2
|
Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Cardiovasc Res 2022; 118:1618-1666. [PMID: 34864876 PMCID: PMC8690236 DOI: 10.1093/cvr/cvab343] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
Collapse
|
3
|
Li W, Zou Z, Cai Y, Yang K, Wang S, Liu Z, Geng L, Chu Q, Ji Z, Chan P, Liu GH, Song M, Qu J, Zhang W. Low-dose chloroquine treatment extends the lifespan of aged rats. Protein Cell 2022; 13:454-461. [PMID: 35023015 PMCID: PMC9095792 DOI: 10.1007/s13238-021-00903-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Wei Li
- Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
- Aging Translational Medicine Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zhiran Zou
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China
| | - Yusheng Cai
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China
| | - Kuan Yang
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, 100101, China
- China National Center for Bioinformation, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 101408, China
- Sino-Danish Center for Education and Research, Beijing, 101408, China
| | - Si Wang
- Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
- Aging Translational Medicine Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Chongqing Renji Hospital, University of Chinese Academy of Sciences, Chongqing, 400062, China
| | - Zunpeng Liu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China
| | - Lingling Geng
- Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
- Aging Translational Medicine Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Qun Chu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China
| | - Zhejun Ji
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China
| | - Piu Chan
- Aging Translational Medicine Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Guang-Hui Liu
- Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China.
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Aging Translational Medicine Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China.
| | - Moshi Song
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China.
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China.
| | - Jing Qu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China.
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, 100101, China.
| | - Weiqi Zhang
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, 100101, China.
- China National Center for Bioinformation, Beijing, 100101, China.
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Aging Translational Medicine Center, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 101408, China.
| |
Collapse
|
4
|
Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Eur Heart J 2022; 43:1059-1103. [PMID: 34791154 PMCID: PMC8690006 DOI: 10.1093/eurheartj/ehab697] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
Collapse
|
5
|
Umeda M, Kawano H, Endo Y, Takatani A, Koga T, Ichinose K, Nakamura H, Mukaino A, Higuchi O, Nakane S, Maeda T, Kawakami A. Intravenous cyclophosphamide treatment for systemic lupus erythematosus with severe autonomic disorders confirmed by head-up tilt table test: A case series. Mod Rheumatol Case Rep 2022; 6:47-51. [PMID: 34598277 DOI: 10.1093/mrcr/rxab027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/18/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022]
Abstract
Autonomic disorders are common in patients with systemic lupus erythematosus (SLE), but the therapeutic strategy and methods for evaluating the effects of therapy have not been established. We describe the three cases of SLE patients who developed severe autonomic disorders as demonstrated by the head-up tilt table test (HUT). All three patients were treated by intensive immunosuppressive treatments including intravenous cyclophosphamide (IVCY); their HUT results all became negative. Our cases suggest that IVCY treatment can be a good therapeutic option for severe autonomic disorders in SLE patients. The HUT is a useful objective method for the diagnosis of and the evaluation of longitudinal therapeutic effects on autonomic disorders in SLE patients with orthostatic intolerance.
Collapse
Affiliation(s)
- Masataka Umeda
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yushiro Endo
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ayuko Takatani
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiro Mukaino
- Department of Molecular Neurology and Therapeutics, Kumamoto University Hospital, Kumamoto, Japan
| | - Osamu Higuchi
- Department of Clinical Research, Nagasaki Kawatana Medical Center, Kawatana, Japan
| | - Shunya Nakane
- Department of Molecular Neurology and Therapeutics, Kumamoto University Hospital, Kumamoto, Japan
| | - Takahiro Maeda
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
6
|
Walia R, Prabhakaran N, Kodliwadmath A, Singh OBC, Mahala P, Kaeley N. Seven day continuous ambulatory electrocardiographic telemetric study with pocket electrocardiographic recording device for detecting hydroxychloroquine induced arrhythmias. J Family Med Prim Care 2022; 11:1514-1518. [PMID: 35516670 PMCID: PMC9067226 DOI: 10.4103/jfmpc.jfmpc_1369_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022] Open
Abstract
Objective: The use of hydroxychloroquine (HCQ) for COVID-19 treatment and prophylaxis raised issues concerning its cardiac safety owing to the possibility of QT prolongation and arrhythmias. There was no study on long-term electrocardiographic telemetry monitoring of patients taking HCQ. We planned a continuous electrocardiographic Holter telemetry of these patients for 7 days. Material and Methods: Health care workers taking HCQ as pre exposure prophylaxis and patients on HCQ were monitored using seven day Holter electrocardiographic telemetry with continuous beat to beat analysis. Telemetry can instantly convey any arrhythmic event or significant QT prolongation to the medical faculty. Results: Twenty-five participants with a mean age of 42.4 ± 14.1 years were included in the study; 40% were females. Twenty percent of participants needed to stop HCQ. Four patients developed QT prolongation >500 ms and needed to stop HCQ, one patient had accelerated idioventricular rhythm and stopped treatment, and one had short episodes of atrial fibrillation. No malignant arrhythmia or ventricular arrhythmia, or torsade de pointis were noted. No episode of significant conduction disturbance and arrhythmic death was noted. Baseline mean QTc was 423.96 ± 32.18 ms, mean QTc corrected at 24 h was 438.93 ± 37.95, mean QTc was 451.879 ± 37.99 at 48 h, and change in baseline mean QTc to max QTc was 30.74 ± 21.75 ms at 48 h. All those who developed QTc prolongation >500 ms were greater than 50 years of age. Conclusion: Ambulatory telemetry ECG monitoring detects early QT prolongation, and stopping drugs prevents malignant arrhythmias. HCQ seems to have less risk of QT prolongation in young, healthy individuals.
Collapse
|
7
|
Cao Q, Lei H, Yang M, Wei L, Dong Y, Xu J, Nasser M, Liu M, Zhu P, Xu L, Zhao M. Impact of Cardiovascular Diseases on COVID-19: A Systematic Review. Med Sci Monit 2021; 27:e930032. [PMID: 33820904 PMCID: PMC8035813 DOI: 10.12659/msm.930032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In December 2019, pneumonia of unknown cause broke out, and currently more than 150 countries around the world have been affected. Globally, as of 5: 46 pm CET, 6 November 2020, the World Health Organization (WHO) had reported 48 534 508 confirmed cases of COVID-19, including 1 231 017 deaths. The novel coronavirus disease (COVID-19) outbreak, caused by the SARS-CoV-2 virus, is the most important medical challenge in decades. Previous research mainly focused on the exploration of lung changes. However, with development of the disease and deepening research, more and more patients showed cardiovascular diseases, even in those without respiratory symptoms, and some researchers have found that underlying cardiovascular diseases increase the risk of infection. Although the related mechanism is not thoroughly studied, based on existing research, we speculate that the interaction between the virus and its receptor, inflammatory factors, various forms of the stress response, hypoxic environment, and drug administration could all induce the development of cardiac adverse events. Interventions to control these pathogenic factors may effectively reduce the occurrence of cardiovascular complications. This review summarizes the latest research on the relationship between COVID-19 and its associated cardiovascular complications, and we also explore possible mechanisms and treatments.
Collapse
Affiliation(s)
- Qingtai Cao
- Hunan Normal University School of Medicine, Changsha, Hunan, China (mainland)
| | - HanYu Lei
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - MengLing Yang
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Le Wei
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - YinMiao Dong
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - JiaHao Xu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Mi Nasser
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China (mainland)
| | - MengQi Liu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China (mainland)
| | - LinYong Xu
- School of Life Science, Central South University, Changsha, Hunan, China (mainland)
| | - MingYi Zhao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| |
Collapse
|
8
|
Padiyar S, Danda D. Revisiting cardiac safety of hydroxychloroquine in rheumatological diseases during COVID-19 era: Facts and myths. Eur J Rheumatol 2021; 8:100-104. [PMID: 33044166 PMCID: PMC8133889 DOI: 10.5152/eurjrheum.2020.20174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/10/2020] [Indexed: 12/27/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 has spread across the globe affecting more than 10 million people as of August 2020. With the pandemic spreading at such an alarming rate, a lot of efforts are in the process of identification of an effective treatment at it's earliest. Hydroxychloroquine (HCQ) is such a drug that is being studied as a repurposed agent, although the early results are still inconclusive. However, an important adverse effect that has raised concerns in the recent times is its possible cardiac toxicity, mainly the 'QT,' prolongation in electro-cardiogram, which has created a sense of apprehension for its use in traditional indications like rheumatological conditions. In decades of HCQ use by rheumatologists, this cardiac toxicity was rarely ever seen. So, what is different in the current coronavirus disease 2019 (COVID-19) era? This review outlines various studies on HCQ reporting cardiac adverse events in patients with rheumatic diseases as well as, in patients with COVID-19 infection. In addition, two important observations were noticed; first, the doses that have been used in the current COVID-19 scenario are much higher than what are used in rheumatology. Second, COVID-19 infection may by itself lead to intrinsic cardiac abnormalities, which is probably acting as a confounder. Most of the available and credible data suggest that HCQ is a safe drug, including the RECOVERY trial stating no cardiotoxicity by HCQ. This review reinforces the safety profile of HCQ in a data-driven manner and addresses the concerns of the physicians. However, its cautious use in those with pre-existing cardiac abnormalities cannot be overemphasized.
Collapse
Affiliation(s)
- Shivraj Padiyar
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| |
Collapse
|
9
|
Varma N, Marrouche NF, Aguinaga L, Albert CM, Arbelo E, Choi JI, Chung MK, Conte G, Dagher L, Epstein LM, Ghanbari H, Han JK, Heidbuchel H, Huang H, Lakkireddy DR, Ngarmukos T, Russo AM, Saad EB, Saenz Morales LC, Sandau KE, Sridhar ARM, Stecker EC, Varosy PD. HRS/EHRA/APHRS/LAHRS/ACC/AHA worldwide practice update for telehealth and arrhythmia monitoring during and after a pandemic. Europace 2021; 23:313. [PMID: 32526011 PMCID: PMC7313983 DOI: 10.1093/europace/euaa187] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
| | | | | | | | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacións Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jong-Il Choi
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Lilas Dagher
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | - Janet K Han
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Hein Heidbuchel
- Antwerp University and University Hospital, Antwerp, Belgium
| | - He Huang
- Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Tachapong Ngarmukos
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | | | | | | | - Paul D Varosy
- VA Eastern Colorado Health Care System and University of Colorado, Aurora, CO, USA
| |
Collapse
|
10
|
Sogut O, Can MM, Guven R, Kaplan O, Ergenc H, Umit TB, Demir O, Kaya M, Akdemir T, Cakmak S. Safety and efficacy of hydroxychloroquine in 152 outpatients with confirmed COVID-19: A pilot observational study. Am J Emerg Med 2020; 40:41-46. [PMID: 33348222 PMCID: PMC7836768 DOI: 10.1016/j.ajem.2020.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose We investigated the efficacy and safety of hydroxychloroquine for empirical treatment of outpatients with confirmed COVID-19. Methods In this prospective, single-center study, we enrolled ambulatory outpatients with COVID-19 confirmed by a molecular method who received hydroxychloroquine. The patients were divided into low- and moderate-risk groups based on the Tisdale risk score for drug-associated QT prolongation, and the QT interval was corrected for heart rate using the Bazett formula (QTc). The QTc interval was measured by electrocardiography both pretreatment (QTc1) and 4 h after the administration of hydroxychloroquine (QTc2). The difference between the QTc1 and QTc2 intervals was defined as the ΔQTc. The QTc1 and QTc2 intervals and ΔQTc values were compared between the two risk groups. Results The median and interquartile range (IQR) age of the patients was 47.0 (36.2–62) years, and there were 78 men and 74 women. The median (IQR) QTc1 interval lengthened from 425.0 (407.2–425.0) to 430.0 (QTc2; 412.0–443.0) milliseconds (ms). However, this was not considered an increased risk of ventricular tachycardia associated with a prolonged QTc interval requiring drug discontinuation, because none of the patients had a ΔQTc of >60 ms or a QTc2 of >500 ms. Moreover, the median (quartiles; minimum-maximum) ΔQTc value was higher in patients in the moderate-risk group than those in the low-risk group (10.0 [−4.0–18.0; −75.0–51.0] vs. 7.0 [−10.5–23.5; −53.0–59.0 ms]) (p = 0.996). Clinical improvement was noted in 91.4% of the patients, the exceptions being 13 patients who presented with non-serious adverse drug reactions or who had severe COVID-19 and were hospitalized. Adverse effects related to hydroxychloroquine were non-serious and occurred in 52.8% (n = 80) of the patients. Conclusions Our findings show that hydroxychloroquine is safe for COVID-19 and not associated with a risk of ventricular arrhythmia due to drug-induced QTc interval prolongation. Additionally, hydroxychloroquine was well tolerated, and there were no drug-related non-serious adverse events leading to treatment discontinuation in the majority of patients who were stable and did not require hospitalization.
Collapse
Affiliation(s)
- Ozgur Sogut
- University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.
| | - Mehmet Mustafa Can
- University of Health Sciences, Haseki Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ramazan Guven
- University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Onur Kaplan
- University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Hüseyin Ergenc
- University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Tuba Betül Umit
- University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Olgun Demir
- University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Murat Kaya
- University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Tarık Akdemir
- University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Sümeyye Cakmak
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| |
Collapse
|
11
|
Santoro F, Monitillo F, Raimondo P, Lopizzo A, Brindicci G, Gilio M, Musaico F, Mazzola M, Vestito D, Di Benedetto R, Abumayyaleh M, El-Battrawy I, Santoro CR, Di Martino LFM, Akin I, De Stefano G, Fiorilli R, Cannone M, Saracino A, Angarano S, Carbonara S, Grasso S, Di Biase L, Brunetti ND. QTc interval prolongation and life-threatening arrhythmias during hospitalization in patients with COVID-19. Results from a multi-center prospective registry. Clin Infect Dis 2020; 73:e4031-e4038. [PMID: 33098645 PMCID: PMC7665434 DOI: 10.1093/cid/ciaa1578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background Prolonged QTc interval and life-threatening arrhythmias (LTA) are potential drug induced complications previously reported with antimalarial, antivirals and antibiotics. Objectives To evaluate prevalence and predictors of QTc interval prolongation and incidence of LTA during hospitalization for COVID-19 among patients with normal admission QTc. Methods 110 consecutive patients were enrolled in a multicenter international registry. 12-lead ECG was performed at admission, after 7 and 14 days; QTc values were analyzed. Results Fifteen (14%) patients developed a prolonged-QTc (pQT) after 7 days (mean QTc increase 66±20msec, +16%, p<0.001); these patients were older, had higher basal heart rates, higher rates of paroxysmal atrial fibrillation, lower platelet count. QTc increase was inversely proportional to baseline QTc levels and leukocyte count and directly to basal heart rates(p<0.01).At multivariate stepwise analysis including age, male gender, paroxysmal atrial fibrillation, basal QTc values, basal heart rate and dual antiviral therapy, age(OR 1.06, 95% C.I. 1.00-1.13, p<0.05), basal heart rate(OR 1.07, 95% C.I. 1.02-1.13, p<0.01) and dual antiviral therapy(OR 12.46, 95% C.I. 2.09-74.20, p<0.1) were independent predictors of QT-prolongation.Incidence of LTA during hospitalization was 3.6%. One patient experienced cardiac arrest and three non-sustained ventricular tachycardia. LTAs were recorded after a median of 9 days from hospitalization and were associated with 50% of mortality rate. Conclusions After 7 days of hospitalization, 14% of patients with Covid-19 developed pQTc; age, basal heart rate and dual antiviral therapy were found as independent predictor of pQTc. Life threatening arrhythmias have an incidence of 3.6% and were associated with poor outcome.
Collapse
Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Department of Cardiology, Bonomo Hospital, Andria, Italy
| | | | - Pasquale Raimondo
- Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation (D.E.O.T.), "Aldo Moro" University of Bari, Bari, Italy
| | | | - Gaetano Brindicci
- Unit of Infectious Diseases, Hospital-University Polyclinic of Bari, Italy
| | - Michele Gilio
- Department of Infectious disease, San Carlo Hospital, Potenza, Italy
| | - Francesco Musaico
- Department of Cardiology, Vittorio Emanuele II Hospital, Bisceglie, Italy
| | - Michele Mazzola
- Department of Infectious disease, Vittorio Emanuele II Hospital, Bisceglie, Italy
| | | | - Rossella Di Benedetto
- Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation (D.E.O.T.), "Aldo Moro" University of Bari, Bari, Italy
| | - Mohammad Abumayyaleh
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), Germany. DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), Germany. DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Carmen Rita Santoro
- Department of Infectious and tropical disease, San Giuseppe Moscati Hospital, Taranto, Italy
| | | | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), Germany. DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Giulio De Stefano
- Unit of Infectious Diseases, Hospital-University Polyclinic of Bari, Italy
| | | | | | - Annalisa Saracino
- Unit of Infectious Diseases, Hospital-University Polyclinic of Bari, Italy
| | - Salvatore Angarano
- Unit of Infectious Diseases, Hospital-University Polyclinic of Bari, Italy
| | - Sergio Carbonara
- Department of Infectious disease, Vittorio Emanuele II Hospital, Bisceglie, Italy
| | - Salvatore Grasso
- Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation (D.E.O.T.), "Aldo Moro" University of Bari, Bari, Italy
| | - Luigi Di Biase
- Department of Medicine, Cardiology Division, Montefiore Medical Center, Bronx, New York, USA
| | | |
Collapse
|
12
|
Varma N, Marrouche NF, Aguinaga L, Albert CM, Arbelo E, Choi JI, Chung MK, Conte G, Dagher L, Epstein LM, Ghanbari H, Han JK, Heidbuchel H, Huang H, Lakkireddy DR, Ngarmukos T, Russo AM, Saad EB, Saenz Morales LC, Sandau KE, Sridhar ARM, Stecker EC, Varosy PD. HRS/EHRA/APHRS/LAHRS/ACC/AHA worldwide practice update for telehealth and arrhythmia monitoring during and after a pandemic. J Arrhythm 2020; 36:813-826. [PMID: 32837667 PMCID: PMC7361598 DOI: 10.1002/joa3.12389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | | | | | | | - Elena Arbelo
- Arrhythmia Section Cardiology Department Hospital Clínic Universitat de Barcelona Barcelona Spain
- Institut d'Investigacións Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
| | - Jong-Il Choi
- Korea University Medical Center Seoul Republic of Korea
| | | | | | - Lilas Dagher
- Tulane University School of Medicine New Orleans LA USA
| | | | | | - Janet K Han
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California, Los Angeles Los Angeles CA USA
| | | | - He Huang
- Renmin Hospital of Wuhan University Wuhan China
| | | | - Tachapong Ngarmukos
- Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | | | | | | | | | | | | | - Paul D Varosy
- VA Eastern Colorado Health Care System and University of Colorado Aurora CO USA
| |
Collapse
|
13
|
Prommer E. Safety and Utility of Chloroquine/ Hydroxychloroquine in Palliative Care Patients. Am J Hosp Palliat Care 2020; 38:480-488. [PMID: 32929975 DOI: 10.1177/1049909120952773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic represents a significant healthcare challenge for the world. Many drugs have therapeutic potential. The aminoquinolones, hydroxychloroquine, and chloroquine are undergoing evaluation as a potential therapy against COVID -19. In vitro and in vivo studies suggest that these drugs affect viral adherence and modify inflammatory responses, which may provide some impact on the symptoms associated with COVID. As palliative care specialists encounter more COVID positive patients, palliative care specialists need to know how these drugs work, and importantly how they interact with palliative care drugs used for symptom control. At the same time, there is a need to reduce polypharmacy in any seriously ill patient population. The goals of this paper are to identify whether or not hydroxychloroquine/chloroquine improves symptoms in palliative care patients and whether or not these drugs are safe to use in the advanced illness population who have COVID.
Collapse
Affiliation(s)
- Eric Prommer
- Greater Los Angeles Healthcare, Los Angeles, CA, USA
| |
Collapse
|
14
|
Varma N, Marrouche NF, Aguinaga L, Albert CM, Arbelo E, Choi JI, Chung MK, Conte G, Dagher L, Epstein LM, Ghanbari H, Han JK, Heidbuchel H, Huang H, Lakkireddy DR, Ngarmukos T, Russo AM, Saad EB, Saenz Morales LC, Sandau KE, Sridhar ARM, Stecker EC, Varosy PD. HRS/EHRA/APHRS/LAHRS/ACC/AHA Worldwide Practice Update for Telehealth and Arrhythmia Monitoring During and After a Pandemic. J Am Coll Cardiol 2020; 76:1363-1374. [PMID: 32534936 PMCID: PMC7289088 DOI: 10.1016/j.jacc.2020.06.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | | | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacións Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jong-Il Choi
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Lilas Dagher
- Tulane University School of Medicine, New Orleans, Louisiana
| | | | | | - Janet K Han
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Hein Heidbuchel
- Antwerp University and University Hospital, Antwerp, Belgium
| | - He Huang
- Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Tachapong Ngarmukos
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey
| | | | | | | | | | | | - Paul D Varosy
- VA Eastern Colorado Health Care System and University of Colorado, Aurora, Colorado
| |
Collapse
|
15
|
Nagaraja BS, Ramesh KN, Dhar D, Mondal MS, Dey T, Saha S, Khan MA, Rutul SD, Pratik K, Manjula J, Sangeeth TA, Singh V. HyPE study: hydroxychloroquine prophylaxis-related adverse events' analysis among healthcare workers during COVID-19 pandemic: a rising public health concern. J Public Health (Oxf) 2020; 42:493-503. [PMID: 32490532 PMCID: PMC7313915 DOI: 10.1093/pubmed/fdaa074] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The rising burden of Coronavirus disease (COVID-19) has led to the mass use of hydroxychloroquine by healthcare workers (HCWs). Adverse event profile of this drug when used as prophylaxis is not well known in the literature. METHODS A retrospective, cross-sectional study was conducted across the country using semi-structured web-based questionnaire among COVID-19 negative and asymptomatic healthcare workers, taking hydroxychloroquine prophylaxis. Descriptive and multivariate logistic-regression models were applied for analysis. RESULTS Of the 166 participants, at least one adverse event was experienced by 37.9% participants, gastrointestinal being the most common (30.7%). Risk was higher in participants <40 years age (odd's ratio (OR): 2.44, 95% confidence interval (CI): 1.18-5.05) and after first dose of hydroxychloroquine (51.2%, OR: 2.38, 95%CI: 1.17-4.84). Hydroxychloroquine prophylaxis was initiated without electrocardiography by 80.1% of HCWs. Only 21.6% of those with cardiovascular disease could get prior ECG. CONCLUSIONS A higher incidence of adverse events was observed when results were compared with studies involving patients on long-term hydroxychloroquine therapy. Younger age and first dose were associated with greater incidence of adverse events though all were self-limiting. Monitoring prior and during prophylaxis was inadequate even among those with cardiovascular disease and risk-factors. However, no serious cardiovascular events were reported.
Collapse
Affiliation(s)
| | | | - Debjyoti Dhar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
- Department of Internal Medicine, Bangalore Medical College and Research institute, Bangalore 560002, India
| | - Mahammad Samim Mondal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
- Department of Internal Medicine, Bangalore Medical College and Research institute, Bangalore 560002, India
| | - Treshita Dey
- Department of Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subhrakamal Saha
- Department of Internal Medicine, Jawaharlal Nehru Hospital and Research Centre, Sector-9, Hospital Sector, Bhilai 490001, India
| | - Mumtaz Ali Khan
- Department of Internal Medicine, Bowring and Lady Curzon Hospital, Bangalore 560001, India
| | - Shah Dhiren Rutul
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Kishore Pratik
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Jayaram Manjula
- Department of Internal Medicine, Bangalore Medical College and Research institute, Bangalore 560002, India
| | - Thuppanattumadam Ananthasubramanian Sangeeth
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
- Department of Internal Medicine, Bangalore Medical College and Research institute, Bangalore 560002, India
| | - Vikram Singh
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
- Department of Internal Medicine, Bangalore Medical College and Research institute, Bangalore 560002, India
| |
Collapse
|
16
|
Jeevaratnam K. Chloroquine and hydroxychloroquine for COVID-19: implications for cardiac safety. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 6:256-257. [PMID: 32347923 PMCID: PMC7197554 DOI: 10.1093/ehjcvp/pvaa041] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, UK
- Physiological Laboratory, University of Cambridge, Cambridge, UK
- Corresponding author. Tel: +44 1483 682395,
| |
Collapse
|
17
|
Watson JA, Tarning J, Hoglund RM, Baud FJ, Megarbane B, Clemessy JL, White NJ. Concentration-dependent mortality of chloroquine in overdose. eLife 2020; 9:e58631. [PMID: 32639233 PMCID: PMC7417172 DOI: 10.7554/elife.58631] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Hydroxychloroquine and chloroquine are used extensively in malaria and rheumatological conditions, and now in COVID-19 prevention and treatment. Although generally safe they are potentially lethal in overdose. In-vitro data suggest that high concentrations and thus high doses are needed for COVID-19 infections, but as yet there is no convincing evidence of clinical efficacy. Bayesian regression models were fitted to survival outcomes and electrocardiograph QRS durations from 302 prospectively studied French patients who had taken intentional chloroquine overdoses, of whom 33 died (11%), and 16 healthy volunteers who took 620 mg base chloroquine single doses. Whole blood concentrations of 13.5 µmol/L (95% credible interval 10.1-17.7) were associated with 1% mortality. Prolongation of ventricular depolarization is concentration-dependent with a QRS duration >150 msec independently highly predictive of mortality in chloroquine self-poisoning. Pharmacokinetic modeling predicts that most high dose regimens trialled in COVID-19 are unlikely to cause serious cardiovascular toxicity.
Collapse
Affiliation(s)
- James A Watson
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Richard M Hoglund
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Frederic J Baud
- Assistance Publique - Hôpitaux de ParisParisFrance
- Université de ParisParisFrance
| | - Bruno Megarbane
- Université de Paris, INSERM UMRS-11 44ParisFrance
- Reanimation Medicale et Toxicologique, Hopital LariboisiereParisFrance
| | - Jean-Luc Clemessy
- Assistance Publique - Hôpitaux de ParisParisFrance
- Reanimation Medicale et Toxicologique, Hopital LariboisiereParisFrance
- Clinique du SportParisFrance
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| |
Collapse
|
18
|
Varma N, Marrouche NF, Aguinaga L, Albert CM, Arbelo E, Choi JI, Chung MK, Conte G, Dagher L, Epstein LM, Ghanbari H, Han JK, Heidbuchel H, Huang H, Lakkireddy DR, Ngarmukos T, Russo AM, Saad EB, Saenz Morales LC, Sandau KE, Sridhar ARM, Stecker EC, Varosy PD. HRS/EHRA/APHRS/LAHRS/ACC/AHA Worldwide Practice Update for Telehealth and Arrhythmia Monitoring During and After a Pandemic. Circ Arrhythm Electrophysiol 2020; 13:e009007. [PMID: 32692972 PMCID: PMC7482618 DOI: 10.1161/circep.120.009007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Luis Aguinaga
- Centro Privado de Cardiología, Tucuman, Argentina (L.A.)
| | | | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Spain. Institut d'Investigacións Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (E.A.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (E.A.)
| | - Jong-Il Choi
- Korea University Medical Center, Seoul, Republic of Korea (J.-I.C.)
| | | | | | - Lilas Dagher
- Tulane University School of Medicine, New Orleans, LA (N.F.M., L.D.)
| | - Laurence M Epstein
- Northwell Health, North Shore University Hospital, Manhasset, New York (L.M.E.)
| | | | - Janet K Han
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California (J.K.H.)
| | - Hein Heidbuchel
- Antwerp University and University Hospital, Belgium (H. Heidbuchel)
| | - He Huang
- Renmin Hospital of Wuhan University, China (H. Huang)
| | | | - Tachapong Ngarmukos
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.)
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | | | | | | | | | - Eric C Stecker
- Oregon Health & Science University, Portland, OR (E.C.S.)
| | - Paul D Varosy
- Oregon Health & Science University, Portland, OR (E.C.S.)
| |
Collapse
|
19
|
Mansueto G, Niola M, Napoli C. Can COVID 2019 induce a specific cardiovascular damage or it exacerbates pre-existing cardiovascular diseases? Pathol Res Pract 2020; 216:153086. [PMID: 32825954 PMCID: PMC7319650 DOI: 10.1016/j.prp.2020.153086] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023]
Abstract
SARS-CoV-2 causes acute respiratory distress syndrome (ARDS) and multiple organ failure until death. Myocarditis, myocardial infarction, arrhythmias, embolism, and DIC are the main complications in patients with cardiovascular comorbidities. SARSCoV-2 can worsen the clinical status of patients with pre-existing cardiovascular diseases and this may interfere with therapies.
A novel coronavirus SARS-CoV-2 causes acute respiratory distress syndrome (ARDS) with cardiovascular and multiple organ failure till death. The main mechanisms of virus internalization and interaction with the host are down-regulation or upregulation of the ACE2 receptor, the surface glycoprotein competition mechanism for the binding of porphyrin to iron in heme formation as well as interference with the immune system. The interference on renin–angiotensin–aldosterone system (RAAS) activation, heme formation, and the immune response is responsible for infection diffusion, endothelial dysfunction, vasoconstriction, oxidative damage and releasing of inflammatory mediators. The main pathological findings are bilateral interstitial pneumonia with diffuse alveolar damage (DAD). Because ACE receptor is also present in the endothelium of other districts as well as in different cell types, and as porphyrins are transporters in the blood and other biological liquids of iron forming heme, which is important in the assembly of the hemoglobin, myoglobin and the cytochromes, multiorgan damage occurs both primitive and secondary to lung damage. More relevantly, myocarditis, acute myocardial infarction, thromboembolism, and disseminated intravasal coagulation (DIC) are described as complications in patients with poor outcome. Here, we investigated the role of SARSCoV-2 on the cardiovascular system and in patients with cardiovascular comorbidities, and possible drug interference on the heart.
Collapse
Affiliation(s)
- Gelsomina Mansueto
- Clinical Department of Internal Medicine and Specialistics, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Massimo Niola
- Department of Advanced Biomedical Sciences, Legal Medicine, University of Naples Federico II, Naples, Italy
| | - Claudio Napoli
- Clinical Department of Internal Medicine and Specialistics, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", 80138 Naples, Italy; IRCCS SDN, Naples, IT, Italy
| |
Collapse
|
20
|
Russo V, Bottino R, Carbone A, Rago A, Papa AA, Golino P, Nigro G. COVID-19 and Heart: From Clinical Features to Pharmacological Implications. J Clin Med 2020; 9:E1944. [PMID: 32580344 PMCID: PMC7355803 DOI: 10.3390/jcm9061944] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/06/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
A highly pathogenic human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been recently recognized in Wuhan, China, as the cause of the coronavirus disease 2019 (COVID-19) outbreak which has spread rapidly from China to other countries in the world, causing a pandemic with alarming morbidity and mortality. The emerging epidemiological data about COVID-19 patients suggest an association between cardiovascular diseases (CVD) and SARS-CoV-2 infection, in term of clinical features at hospital admission and prognosis for disease severity. The aim of our review is to describe the cardiological features of COVID-19 patients at admission, the acute cardiac presentation, the clinical outcome for patients with underlying CVD and the pharmacological implications for disease management.
Collapse
Affiliation(s)
- Vincenzo Russo
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (R.B.); (A.C.); (A.R.); (A.A.P.); (P.G.); (G.N.)
| | | | | | | | | | | | | |
Collapse
|
21
|
HRS/EHRA/APHRS/LAHRS/ACC/AHA worldwide practice update for telehealth and arrhythmia monitoring during and after a pandemic. Heart Rhythm 2020; 17:e255-e268. [PMID: 32535140 PMCID: PMC7289086 DOI: 10.1016/j.hrthm.2020.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022]
|
22
|
Naksuk N, Lazar S, Peeraphatdit T(B. Cardiac safety of off-label COVID-19 drug therapy: a review and proposed monitoring protocol. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 9:215-221. [PMID: 32372695 PMCID: PMC7235441 DOI: 10.1177/2048872620922784] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023]
Abstract
More than 2,000,000 individuals worldwide have had coronavirus 2019 disease infection (COVID-19), yet there is no effective medical therapy. Multiple off-label and investigational drugs, such as chloroquine and hydroxychloroquine, have gained broad interest due to positive pre-clinical data and are currently used for treatment of COVID-19. However, some of these medications have potential cardiac adverse effects. This is important because up to one-third of patients with COVID-19 have cardiac injury, which can further increase the risk of cardiomyopathy and arrhythmias. Adverse effects of chloroquine and hydroxychloroquine on cardiac function and conduction are broad and can be fatal. Both drugs have an anti-arrhythmic property and are proarrhythmic. The American Heart Association has listed chloroquine and hydroxychloroquine as agents which can cause direct myocardial toxicity. Similarly, other investigational drugs such as favipiravir and lopinavir/ritonavir can prolong QT interval and cause Torsade de Pointes. Many antibiotics commonly used for the treatment of patients with COVID-19, for instance azithromycin, can also prolong QT interval. This review summarizes evidenced-based data regarding potential cardiac adverse effects due to off-label and investigational drugs including chloroquine and hydroxychloroquine, antiviral therapy, monoclonal antibodies, as well as common antibiotics used for the treatment of COVID-19. The article focuses on practical points and offers a point-of-care protocol for providers who are taking care of patients with COVID-19 in an inpatient and outpatient setting. The proposed protocol is taking into consideration that resources during the pandemic are limited.
Collapse
Affiliation(s)
- Niyada Naksuk
-
Division of Cardiology, University of Illinois at Chicago, USA
| | - Sorin Lazar
-
Division of Cardiology, University of Illinois at Chicago, USA
| | | |
Collapse
|
23
|
Gawałko M, Balsam P, Lodziński P, Grabowski M, Krzowski B, Opolski G, Kosiuk J. Cardiac Arrhythmias in Autoimmune Diseases. Circ J 2020; 84:685-694. [PMID: 32101812 DOI: 10.1253/circj.cj-19-0705] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Autoimmune diseases (ADs) affect approximately 10% of the world's population. Because ADs are frequently systemic disorders, cardiac involvement is common. In this review we focus on typical arrhythmias and their pathogenesis, arrhythmia-associated mortality, and possible treatment options among selected ADs (sarcoidosis, systemic lupus erythematosus, scleroderma, type 1 diabetes, Graves' disease, rheumatoid arthritis, ankylosing spondylitis [AS], psoriasis, celiac disease [CD], and inflammatory bowel disease [IBD]). Rhythm disorders have different underlying pathophysiologies; myocardial inflammation and fibrosis seem to be the most important factors. Inflammatory processes and oxidative stress lead to cardiomyocyte necrosis, with subsequent electrical and structural remodeling. Furthermore, chronic inflammation is the pathophysiological basis linking AD to autonomic dysfunction, including sympathetic overactivation and a decline in parasympathetic function. Autoantibody-mediated inhibitory effects of cellular events (i.e., potassium or L-type calcium currents, M2muscarinic cholinergic or β1-adrenergic receptor signaling) can also lead to cardiac arrhythmia. Drug-induced arrhythmias, caused, for example, by corticosteroids, methotrexate, chloroquine, are also observed among AD patients. The most common arrhythmia in most AD presentations is atrial arrhythmia (primarily atrial fibrillation), expect for sarcoidosis and scleroderma, which are characterized by a higher burden of ventricular arrhythmia. Arrhythmia-associated mortality is highest among patients with sarcoidosis and lowest among those with AS; there are scant data related to mortality in patients with psoriasis, CD, and IBD.
Collapse
Affiliation(s)
- Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Paweł Balsam
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Piotr Lodziński
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Bartosz Krzowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Jędrzej Kosiuk
- 1st Chair and Department of Cardiology, Medical University of Warsaw.,Department of Electrophysiology, Helios Klinikum Koethen
| |
Collapse
|
24
|
Tobón C, Palacio LC, Chidipi B, Slough DP, Tran T, Tran N, Reiser M, Lin YS, Herweg B, Sayad D, Saiz J, Noujaim S. The Antimalarial Chloroquine Reduces the Burden of Persistent Atrial Fibrillation. Front Pharmacol 2019; 10:1392. [PMID: 31827438 PMCID: PMC6890839 DOI: 10.3389/fphar.2019.01392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/31/2019] [Indexed: 12/31/2022] Open
Abstract
In clinical practice, reducing the burden of persistent atrial fibrillation by pharmacological means is challenging. We explored if blocking the background and the acetylcholine-activated inward rectifier potassium currents (IK1 and IKACh) could be antiarrhythmic in persistent atrial fibrillation. We thus tested the hypothesis that blocking IK1 and IKACh with chloroquine decreases the burden of persistent atrial fibrillation. We used patch clamp to determine the IC50 of IK1 and IKACh block by chloroquine and molecular modeling to simulate the interaction between chloroquine and Kir2.1 and Kir3.1, the molecular correlates of IK1 and IKACh. We then tested, as a proof of concept, if oral chloroquine administration to a patient with persistent atrial fibrillation can decrease the arrhythmia burden. We also simulated the effects of chloroquine in a 3D model of human atria with persistent atrial fibrillation. In patch clamp the IC50 of IK1 block by chloroquine was similar to that of IKACh. A 14-day regimen of oral chloroquine significantly decreased the burden of persistent atrial fibrillation in a patient. Mathematical simulations of persistent atrial fibrillation in a 3D model of human atria suggested that chloroquine prolonged the action potential duration, leading to failure of reentrant excitation, and the subsequent termination of the arrhythmia. The combined block of IK1 and IKACh can be a targeted therapeutic strategy for persistent atrial fibrillation.
Collapse
Affiliation(s)
| | | | - Bojjibabu Chidipi
- Molecular Pharmacology and Physiology Department, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Diana P Slough
- Department of Chemistry, Tufts University, Medford, MA, United States
| | - Thanh Tran
- Cardiology Department, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Nhi Tran
- Cardiology Department, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Michelle Reiser
- Molecular Pharmacology and Physiology Department, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Yu-Shan Lin
- Department of Chemistry, Tufts University, Medford, MA, United States
| | - Bengt Herweg
- Cardiology Department, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Dany Sayad
- Cardiology Department, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Javier Saiz
- Ci2 B, Universitat Politècnica de València, Valencia, Spain
| | - Sami Noujaim
- Molecular Pharmacology and Physiology Department, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| |
Collapse
|
25
|
Liu D, Li X, Zhang Y, Kwong JSW, Li L, Zhang Y, Xu C, Li Q, Sun X, Tian H, Li S. Chloroquine and hydroxychloroquine are associated with reduced cardiovascular risk: a systematic review and meta-analysis. Drug Des Devel Ther 2018; 12:1685-1695. [PMID: 29928112 PMCID: PMC6001837 DOI: 10.2147/dddt.s166893] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background and aims Chloroquine (CQ) and hydroxychloroquine (HCQ) are widely used in patients with rheumatic diseases, but their effects on the cardiovascular system remain unclear. We aimed to assess whether CQ/HCQ could reduce the risk of cardiovascular disease (CVD). Materials and methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and the ClinicalTrials.gov for studies investigating the association between CQ/HCQ and the risk of CVD from inception to 20 December 2017. We carried out the quality assessment using the Newcastle-Ottawa Quality Assessment Scale (NOS). Random-effects model was used to pool the risk estimates relative ratio (RR), hazard ratio (HR) or odds ratio (OR) with 95% confidence interval (CI) for the outcomes. Results A total of 19 studies (7 case-control studies, 12 cohort studies, and no clinical trials) involving 19,679 participants were included in the meta-analysis. Pooled results for HRs or RRs showed that CQ/HCQ was associated with a significantly reduced risk of CVD (pooled RR 0.72, 95% CI 0.56–0.94, p=0.013). Results based on ORs showed a similar tendency towards a reduced risk of CVD with CQ/HCQ (pooled OR 0.41, 95% CI 0.25–0.69, p=0.001). Conclusion Our results suggested that CQ/HCQ was associated with a reduced risk of CVD in patients with rheumatic diseases. Randomized trials are needed to confirm the potential of CQ/HCQ in cardiovascular prevention in patients with and without rheumatic diseases.
Collapse
Affiliation(s)
- Dan Liu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaodan Li
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yonggang Zhang
- Center for Stem Cell Research and Application, Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu 610052, China
| | - Joey Sum-Wing Kwong
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.,Department of Clinical Epidemiology and Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Ling Li
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yiyi Zhang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chang Xu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qianrui Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China.,Division of Molecular & Clinical Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland, UK
| |
Collapse
|
26
|
Matusik PS, Matusik PT, Stein PK. Heart rate variability in patients with systemic lupus erythematosus: a systematic review and methodological considerations. Lupus 2018; 27:1225-1239. [PMID: 29697012 DOI: 10.1177/0961203318771502] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aim The aim of this review was to summarize current knowledge about the scientific findings and potential clinical utility of heart rate variability measures in patients with systemic lupus erythematosus. Methods PubMed, Embase and Scopus databases were searched for the terms associated with systemic lupus erythematosus and heart rate variability, including controlled vocabulary, when appropriate. Articles published in English and available in full text were considered. Finally, 11 publications were selected, according to the systematic review protocol and were analyzed. Results In general, heart rate variability, measured in the time and frequency domains, was reported to be decreased in patients with systemic lupus erythematosus compared with controls. In some systemic lupus erythematosus studies, heart rate variability was found to correlate with inflammatory markers and albumin levels. A novel heart rate variability measure, heart rate turbulence onset, was shown to be increased, while heart rate turbulence slope was decreased in systemic lupus erythematosus patients. Reports of associations of changes in heart rate variability parameters with increasing systemic lupus erythematosus activity were inconsistent, showing decreasing heart rate variability or no relationship. However, the low/high frequency ratio was, in some studies, reported to increase with increasing disease activity or to be inversely correlated with albumin levels. Conclusions Patients with systemic lupus erythematosus have abnormal heart rate variability, which reflects cardiac autonomic dysfunction and may be related to inflammatory cytokines but not necessarily to disease activity. Thus measurement of heart rate variability could be a useful clinical tool for monitoring autonomic dysfunction in systemic lupus erythematosus, and may potentially provide prognostic information.
Collapse
Affiliation(s)
- P S Matusik
- 1 Department of Radiology, University Hospital, Kraków, Poland.,2 Jagiellonian University Medical College, Kraków, Poland
| | - P T Matusik
- 3 Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland.,4 Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - P K Stein
- 5 Department of Medicine, Washington University School of Medicine, USA
| |
Collapse
|
27
|
Tselios K, Gladman DD, Harvey P, Su J, Urowitz MB. Severe brady-arrhythmias in systemic lupus erythematosus: prevalence, etiology and associated factors. Lupus 2018; 27:1415-1423. [DOI: 10.1177/0961203318770526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Severe brady-arrhythmias, requiring a permanent pacemaker (PPM), have been sparsely reported in systemic lupus erythematosus (SLE). The aim of this study was to describe the characteristics of such arrhythmias in a defined lupus cohort. Patients and methods The database of the Toronto Lupus Clinic ( n = 1366) was searched for patients who received a PPM. Demographic, clinical, immunological and therapeutic variables along with electrocardiographic (ECG) and echocardiographic findings (based on the last available test prior to PPM) were analyzed. Patients with a PPM (cases) were compared with age-, sex- and disease duration-matched patients without a PPM (controls). Analysis was performed with SAS 9.0; p < 0.05 was considered significant. Results Eighteen patients were identified, 13 (0.95%) with complete atrioventricular block and 5 (0.37%) with sick sinus syndrome. Disease duration at PPM implantation was 22 ± 12 years. Compared to controls, cases had more frequently coronary artery disease, hypertension, dyslipidemia and longer antimalarial (AM) treatment duration. The prevalence of first-degree atrioventricular block, right bundle branch block, left anterior fascicular block and septal hypertrophy was also higher. AM treatment was significantly associated with brady-arrhythmias (OR = 1.128, 95% CI = 1.003–1.267, p = 0.044). Nine patients had prior heart disease and one received a PPM two years after renal transplantation. Eight patients did not have any potential risk factors; prolonged AM therapy (mean 22 years) might have been the cause. Conclusions Apart from known causes, prolonged AM treatment may be associated with severe brady-arrhythmias in SLE. Certain ECG and echocardiographic characteristics may represent indicators of an ongoing damage in the conduction system.
Collapse
Affiliation(s)
- K Tselios
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Canada
| | - D D Gladman
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Canada
| | - P Harvey
- Division of Cardiology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
| | - J Su
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Canada
| | - M B Urowitz
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Canada
| |
Collapse
|
28
|
Tselios K, Deeb M, Gladman DD, Harvey P, Urowitz MB. Antimalarial-induced cardiomyopathy: a systematic review of the literature. Lupus 2017; 27:591-599. [DOI: 10.1177/0961203317734922] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- K Tselios
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, ON, Canada
| | - M Deeb
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, ON, Canada
| | - D D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, ON, Canada
| | - P Harvey
- Department of Medicine, University of Toronto, Physician-in-Chief, Women's College Hospital, Toronto, ON, Canada
| | - M B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, ON, Canada
| |
Collapse
|
29
|
Gordon C, Amissah-Arthur MB, Gayed M, Brown S, Bruce IN, D’Cruz D, Empson B, Griffiths B, Jayne D, Khamashta M, Lightstone L, Norton P, Norton Y, Schreiber K, Isenberg D. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology (Oxford) 2017; 57:e1-e45. [DOI: 10.1093/rheumatology/kex286] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
- Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust,
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham,
| | - Maame-Boatemaa Amissah-Arthur
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
| | - Mary Gayed
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham,
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham,
| | - Sue Brown
- Royal National Hospital for Rheumatic Diseases, Bath,
| | - Ian N. Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre,
- The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester,
| | - David D’Cruz
- Louise Coote Lupus Unit, Guy’s Hospital, London,
| | - Benjamin Empson
- Laurie Pike Health Centre, Modality Partnership, Birmingham,
| | | | - David Jayne
- Department of Medicine, University of Cambridge,
- Lupus and Vasculitis Unit, Addenbrooke’s Hospital, Cambridge,
| | - Munther Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital,
- Division of Women’s Health, King’s College London,
| | - Liz Lightstone
- Section of Renal Medicine and Vascular Inflammation, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London,
| | | | | | | | - David Isenberg
- Centre for Rheumatology, University College London, London, UK
| | | |
Collapse
|
30
|
Korotchenko V, Sathunuru R, Gerena L, Caridha D, Li Q, Kreishman-Deitrick M, Smith PL, Lin AJ. Antimalarial activity of 4-amidinoquinoline and 10-amidinobenzonaphthyridine derivatives. J Med Chem 2015; 58:3411-31. [PMID: 25654185 DOI: 10.1021/jm501809x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Chloroquine (CQ) has been used as first line malaria therapeutic drug for decades. Emergence of CQ drug-resistant Plasmodium falciparum malaria throughout endemic areas of the world has limited its clinical value. Mefloquine (MQ) has been used as an effective malaria prophylactic drug due to its being long-acting and having a high potency against blood stage P. falciparum (Pf). However, serious CNS toxicity of MQ has compromised its clinical value as a prophylaxis drug. Therefore, new and inexpensive antimalarial drugs with no cross-resistance to CQ or CNS toxicity are urgently needed to combat this deadly human disease. In this study, a series of new 4-amidinoquinoline (4-AMQ) and 10-amidinobenzonaphthyridine (10-AMB) derivatives were designed, prepared, and assessed to search for new therapeutic agents to replace CQ and MQ. The new derivatives displayed high activity in vitro and in vivo, with no cross-resistance to CQ, and none were toxic in mice up to 160 mpk × 3. The best compound shows IC50 < 1 ng/mL against D6, W2 and C235 Pf clones, low inhibitory activity in hERG K(+) channel blockage testing, negativity in the Ames test, and 5/5 cure @ <15 mpk × 3 in mice infected with Plasmodium berghei. In addition to these desirable pharmacological profiles, compound 13b, one of the most active compounds, is metabolically stable in both human and mouse liver microsomal preparations and has a plasma t(1/2) of 50 h in mice, which made it a good MQ replacement candidate.
Collapse
Affiliation(s)
- Vasiliy Korotchenko
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910, United States
| | - Ramadas Sathunuru
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910, United States
| | - Lucia Gerena
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910, United States
| | - Diana Caridha
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910, United States
| | - Qigui Li
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910, United States
| | - Mara Kreishman-Deitrick
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910, United States
| | - Philip L Smith
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910, United States
| | - Ai J Lin
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910, United States
| |
Collapse
|
31
|
Cairoli E, Danese N, Teliz M, Bruzzone MJ, Ferreira J, Rebella M, Cayota A. Cumulative dose of hydroxychloroquine is associated with a decrease of resting heart rate in patients with systemic lupus erythematosus: a pilot study. Lupus 2015; 24:1204-9. [DOI: 10.1177/0961203315580870] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 03/17/2015] [Indexed: 11/17/2022]
Abstract
Introduction The use of hydroxychloroquine (HCQ) in patients with systemic lupus erythematosus (SLE) offers a wide range of benefits. However, there are evidence in favour of cardiotoxicity, including heart conduction disturbances and congestive heart failure. Objective To determine the effects of HCQ in the resting heart rate (RHR) of SLE patients. Patients and methods Included were patients with non active SLE, with a sedentary lifestyle and treated with HCQ. Excluded were patients on beta blocker treatment, trained patients, pacemaker´s users and patients with clinical or analytical evidence of anemia, renal disease, obstructive pulmonary disease, obesity, uncontrolled thyroid disease, fever or current infection. Standard 12-lead electrocardiogram was performed in the resting condition (supine decubitus and orthostatic position). Comparison between groups was performed using Mann–Whitney U test. A multiple linear regression was performed. A p value <0.05 was considered statistically significant. Results 42 patients were included. Patients were divided in two groups based on the cumulative dose of HCQ (CD-HCQ), considering 365 g as cut-off. There were 24 patients with low-HCQ (<365 g) and 18 patients with high-HCQ (>365 g). Non significant differences were found in age, sex, prednisone dose or SLEDAI. The mean RHR was 73 ± 6 beats/min in the low-HCQ and 65 ± 7 beats/min in the high-HCQ, with a significant decrease of 11% ( p = 0.003). In multiple linear regressions, there were non significant association between the decrease of RHR and prednisone dose, age, SLEDAI or TSH, but there was significant association between RHR and CD-HCQ ( p = 0.024) and RHR and time of exposure to HCQ ( p = 0.029). Conclusion CD-HCQ higher than 365 g was associated with a significant decrease (11%) in RHR in non-active SLE patients, although a larger prospective study is required to allow more definitive conclusions.
Collapse
Affiliation(s)
- E Cairoli
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - N Danese
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - M Teliz
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - M J Bruzzone
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - J Ferreira
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - M Rebella
- Unidad de Enfermedades Autoinmunes Sistémicas, Clínica Médica ‘C’, Prof. Dr. Juan Alonso Bao, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - A Cayota
- Departamento Básico de Medicina, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| |
Collapse
|
32
|
Yogasundaram H, Putko BN, Tien J, Paterson DI, Cujec B, Ringrose J, Oudit GY. Hydroxychloroquine-Induced Cardiomyopathy: Case Report, Pathophysiology, Diagnosis, and Treatment. Can J Cardiol 2014; 30:1706-15. [DOI: 10.1016/j.cjca.2014.08.016] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 08/21/2014] [Accepted: 08/21/2014] [Indexed: 12/20/2022] Open
|
33
|
Rodriguez-Caruncho C, Bielsa Marsol I. Antipalúdicos en dermatología: mecanismo de acción, indicaciones y efectos secundarios. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.ad.2012.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
34
|
Rodriguez-Caruncho C, Bielsa Marsol I. Antimalarials in dermatology: mechanism of action, indications, and side effects. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:243-52. [PMID: 24656224 DOI: 10.1016/j.adengl.2012.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/23/2012] [Indexed: 01/06/2023] Open
Abstract
Antimalarial drugs have been in common use in dermatology since the 1950s. Their mechanism of action is complex, and it is now known that they act through various pathways. We review the indications for antimalarials in dermatology, their adverse effects, and some less well-known effects, such as their antithrombotic and hypolipidemic action. The most recent recommendations concerning ophthalmological screening in patients on antimalarials are also reviewed.
Collapse
Affiliation(s)
- C Rodriguez-Caruncho
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Badalona, Badalona, Barcelona, Spain.
| | - I Bielsa Marsol
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Badalona, Badalona, Barcelona, Spain
| |
Collapse
|
35
|
Alkmim Teixeira R, Borba EF, Pedrosa A, Nishioka S, Viana VST, Ramires JA, Kalil-Filho R, Bonfa E, Martinelli Filho M. Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus. Europace 2013; 16:887-92. [DOI: 10.1093/europace/eut290] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
36
|
Tönnesmann E, Kandolf R, Lewalter T. Chloroquine cardiomyopathy – a review of the literature. Immunopharmacol Immunotoxicol 2013; 35:434-42. [DOI: 10.3109/08923973.2013.780078] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
37
|
Long L, Yang X, Southwood M, Lu J, Marciniak SJ, Dunmore BJ, Morrell NW. Chloroquine prevents progression of experimental pulmonary hypertension via inhibition of autophagy and lysosomal bone morphogenetic protein type II receptor degradation. Circ Res 2013; 112:1159-70. [PMID: 23446737 DOI: 10.1161/circresaha.111.300483] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
RATIONALE Pulmonary arterial hypertension (PAH) is characterized by excessive proliferation and apoptosis resistance in pulmonary artery smooth muscle cells (PASMCs). OBJECTIVE We reasoned that chloroquine, based on its ability to inhibit autophagy and block lysosomal degradation of the bone morphogenetic protein type II receptor (BMPR-II), might exert beneficial effects in this disease. METHODS AND RESULTS PAH was induced in male Sprague-Dawley rats by administering monocrotaline. The induction of PAH was associated with changes in lung expression of LC3B-II, ATG5, and p62, consistent with increased autophagy, and decreased BMPR-II protein expression. Administration of chloroquine prevented the development of PAH, right ventricular hypertrophy, and vascular remodelling after monocrotaline, and prevented progression of established PAH in this model. Similar results were obtained with hydroxychloroquine. Chloroquine treatment increased whole lung and PASMC p62 protein levels consistent with inhibition of autophagy, and increased levels of BMPR-II protein. Chloroquine inhibited proliferation and increased apoptosis of PASMCs in vivo. In cultured rat PASMCs we confirmed that chloroquine both inhibited autophagy pathways and increased expression of BMPR-II protein via lysosomal inhibition. Consistent with the in vivo findings, chloroquine inhibited the proliferation and stimulated apoptosis of rat PASMCs in vitro, with no effect on endothelial cell proliferation or survival. Moreover, direct inhibition of autophagy pathways by ATG5 small interfering RNA knockdown inhibited proliferation of rat PASMCs. CONCLUSIONS Chloroquine and hydroxychloroquine exert beneficial effects in experimental PAH. The mechanism of action includes inhibition of autophagy pathways and inhibition of lysosomal degradation of BMPR-II.
Collapse
Affiliation(s)
- Lu Long
- Department of Medicine, Division of Respiratory Medicine, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
38
|
Lee SJ, Silverman E, Bargman JM. The role of antimalarial agents in the treatment of SLE and lupus nephritis. Nat Rev Nephrol 2011; 7:718-29. [PMID: 22009248 DOI: 10.1038/nrneph.2011.150] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that affects various organs. Lupus nephritis is one of the most common, and most important, serious manifestations of SLE. Antimalarial agents are part of the immunomodulatory regimen used to treat patients with SLE; however, their role in the treatment of patients with lupus nephritis in particular is less well recognized, especially by nephrologists. Not all antimalarial agents have been used in the treatment of lupus; this Review will focus on studies using chloroquine and hydroxychloroquine. In addition, this Review will briefly describe the history of antimalarial drug use in patients with SLE, the theorized mechanisms of action of the agents chloroquine and hydroxychloroquine, their efficacy in patients with SLE and those with lupus nephritis, their use in pregnancy, and potential adverse effects. The Review will also cover the latest recommendations regarding monitoring for hydroxychloroquine-associated or chloroquine-associated retinopathy. Overall, antimalarial drugs have numerous beneficial effects in patients with SLE and lupus nephritis, and have a good safety profile.
Collapse
Affiliation(s)
- Senq-J Lee
- Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | | | | |
Collapse
|
39
|
Abstract
Invasive, genetically abnormal carcinoma progenitor cells have been propagated from human and mouse breast ductal carcinoma in situ (DCIS) lesions, providing new insights into breast cancer progression. The survival of DCIS cells in the hypoxic, nutrient-deprived intraductal niche could promote genetic instability and the derepression of the invasive phenotype. Understanding potential survival mechanisms, such as autophagy, that might be functioning in DCIS lesions provides strategies for arresting invasion at the pre-malignant stage. A new, open trial of neoadjuvant therapy for patients with DCIS constitutes a model for testing investigational agents that target malignant progenitor cells in the intraductal niche.
Collapse
Affiliation(s)
- Virginia Espina
- George Mason University, Center for Applied Proteomics and Molecular Medicine, Manassas, Virginia 20110, USA
| | | |
Collapse
|
40
|
Abstract
There are consistent differences in cardiovascular state between acute illness in malaria and recovery that prolong the electrocardiographic QT interval and have been misinterpreted as resulting from antimalarial cardiotoxicity. Of the different classes of antimalarial drugs, only the quinolines, and structurally related antimalarial drugs, have clinically significant cardiovascular effects. Drugs in this class can exacerbate malaria-associated orthostatic hypotension and several have been shown to delay ventricular depolarisation slightly (class 1c effect), resulting in widening of the QRS complex, but only quinidine and halofantrine have clinically significant effects on ventricular repolarisation (class 3 effect). Both drugs cause potentially dangerous QT prolongation, and halofantrine has been associated with sudden death. The parenteral quinoline formulations (chloroquine, quinine, and quinidine) are predictably hypotensive when injected rapidly, and cardiovascular collapse can occur with self-poisoning. Transiently hypotensive plasma concentrations of chloroquine can occur when doses of 5 mg base/kg or more are given by intramuscular or subcutaneous injection. At currently recommended doses, other antimalarial drugs do not have clinically significant cardiac effects. More information on amodiaquine, primaquine, and the newer structurally related compounds is needed.
Collapse
Affiliation(s)
- Nicholas J White
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
41
|
Abstract
Although chloroquine, hydroxychloroquine and quinacrine were originally developed for the treatment of malaria, these medications have been used to treat skin disease for over 50 years. Recent clinical data have confirmed the usefulness of these medications for the treatment of lupus erythematosus. Current research has further enhanced our understanding of the pharmacologic mechanisms of action of these drugs involving inhibition of endosomal toll-like receptor (TLR) signaling limiting B cell and dendritic cell activation. With this understanding, the use of these medications in dermatology is broadening. This article highlights the different antimalarials used within dermatology through their pharmacologic properties and mechanism of action, as well as indicating their clinical uses. In addition, contraindications, adverse effects, and possible drug interactions of antimalarials are reviewed.
Collapse
Affiliation(s)
- Sunil Kalia
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | | |
Collapse
|
42
|
Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|