Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorTEIXEIRA, Ricardo Alkmim
dc.contributor.authorBORBA, Eduardo F.
dc.contributor.authorPEDROSA, Anisio
dc.contributor.authorNISHIOKA, Silvana
dc.contributor.authorVIANA, Vilma S. T.
dc.contributor.authorRAMIRES, Jose A.
dc.contributor.authorKALIL-FILHO, Roberto
dc.contributor.authorBONFA, Eloisa
dc.contributor.authorMARTINELLI FILHO, Martino
dc.date.accessioned2014-09-30T14:38:06Z
dc.date.available2014-09-30T14:38:06Z
dc.date.issued2014
dc.description.abstractTo perform a comprehensive evaluation of heart rhythm disorders and the influence of disease/therapy factors in a large systemic lupus erythematosus (SLE) cohort. Three hundred and seventeen consecutive patients of an ongoing electronic database protocol were evaluated by resting electrocardiogram and 142 were randomly selected for 24 h Holter monitoring for arrhythmia and conduction disturbances. The mean age was 40.2 +/- 12.1 years and disease duration was11.4 +/- 8.1 years. Chloroquine (CQ) therapy was identified in 69.7% with a mean use of 8.5 +/- 6.7 years. Electrocardiogram abnormalities were detected in 66 patients (20.8%): prolonged QTc/QTd (14.2%); bundle-branch block (2.5%); and atrioventricular block (AVB) (1.6%). Age was associated with AVB (P = 0.029) and prolonged QTc/QTd (P = 0.039) whereas anti-Ro/SS-A and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores were not (P > 0.05). Chloroquine was negatively associated with AVB (P = 0.01) as was its longer use (6.1 +/- 6.9 vs. 1.0 +/- 2.5 years, P = 0.018). Time of CQ use was related with the absence of AVB [odds ratio (OR) = 0.103; 95% confidence interval (CI) = 0.011-0.934, P = 0.043] in multiple logistic regression. Holter monitoring revealed abnormalities in 121 patients (85.2%): supraventricular ectopies (63.4%) and tachyarrhythmia (18.3%); ventricular ectopies (45.8%). Atrial tachycardia/fibrillation (AT/AF) were associated with shorter CQ duration (7.05 +/- 7.99 vs. 3.63 +/- 5.02 years, P = 0.043) with a trend to less CQ use (P = 0.054), and older age (P < 0.001). Predictors of AT/AF in multiple logistic regression were age (OR = 1.115; 95% CI = 1.059-1.174, P < 0.001) and anti-Ro/SS-A (OR = 0.172; 95% CI = 0.047-0.629, P = 0.008). Chloroquine seems to play a protective role in the unexpected high rate of cardiac arrhythmias and conduction disturbances observed in SLE. Further studies are necessary to determine if this antiarrhythmic effect is due to the disease control or a direct effect of the drug.
dc.description.indexMEDLINE
dc.description.sponsorshipConselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPQ) [306963/2011-6, 301411/2009-3]
dc.description.sponsorshipFederico Foundation Grant
dc.identifier.citationEUROPACE, v.16, n.6, p.887-892, 2014
dc.identifier.doi10.1093/europace/eut290
dc.identifier.eissn1532-2092
dc.identifier.issn1099-5129
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/7338
dc.language.isoeng
dc.publisherOXFORD UNIV PRESS
dc.relation.ispartofEuropace
dc.rightsopenAccess
dc.rights.holderCopyright OXFORD UNIV PRESS
dc.subjectAntimalarial
dc.subjectArrhythmia
dc.subjectSafety
dc.subjectTreatment
dc.subjectSystemic lupus erythematosus
dc.subject.othercorrected qt interval
dc.subject.otherconnective-tissue diseases
dc.subject.otheratrioventricular-block
dc.subject.otheranti-ro/ssa
dc.subject.otherconduction system
dc.subject.otherpositive adults
dc.subject.otherarrhythmias
dc.subject.otherhydroxychloroquine
dc.subject.otherparameters
dc.subject.otherdispersion
dc.subject.wosCardiac & Cardiovascular Systems
dc.titleEvidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.citation.scopus44
hcfmusp.contributor.author-fmusphcRICARDO ALKMIM TEIXEIRA
hcfmusp.contributor.author-fmusphcEDUARDO FERREIRA BORBA NETO
hcfmusp.contributor.author-fmusphcANISIO ALEXANDRE ANDRADE PEDROSA
hcfmusp.contributor.author-fmusphcSILVANA ANGELINA D'ORIO NISHIOKA
hcfmusp.contributor.author-fmusphcVILMA DOS SANTOS TRINDADE VIANA
hcfmusp.contributor.author-fmusphcJOSE ANTONIO FRANCHINI RAMIRES
hcfmusp.contributor.author-fmusphcROBERTO KALIL FILHO
hcfmusp.contributor.author-fmusphcELOISA SILVA DUTRA DE OLIVEIRA BONFA
hcfmusp.contributor.author-fmusphcMARTINO MARTINELLI FILHO
hcfmusp.description.beginpage887
hcfmusp.description.endpage892
hcfmusp.description.issue6
hcfmusp.description.volume16
hcfmusp.origemWOS
hcfmusp.origem.pubmed24050965
hcfmusp.origem.scopus2-s2.0-84901836845
hcfmusp.origem.wosWOS:000337035100016
hcfmusp.publisher.cityOXFORD
hcfmusp.publisher.countryENGLAND
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hcfmusp.remissive.sponsorshipCNPq
hcfmusp.remissive.sponsorshipFederico Foundation
hcfmusp.scopus.lastupdate2024-05-17
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