Hydroxychloroquine Research - Washington DC VA Medical Center
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Hydroxychloroquine Research

DC VAMC Clinical Research Team

DC VAMC Clinical Research Team

Wednesday, May 12, 2021

Washington DC Veterans Affairs Medical Center Researchers Find New Evidence that Hydroxychloroquine is Safe in Veterans with Rheumatoid Arthritis

Clinician researchers from the Washington DC Veterans Affairs Medical Center published an original research paper in the current issue of Arthritis & Rheumatology which indicates hydroxychloroquine is safe in Veterans with rheumatoid arthritis. The research shows the risk of adverse cardiovascular effects is very low and similar to those not taking the drug.

“Results of this research are important for Veterans as hydroxychloroquine is an essential drug for Veteran patients with lupus and rheumatoid arthritis and have been taking this drug for many years, but were suddenly worried about its safety due to widespread publicity in the lay media,” said Michael S. Heimall, FACHE, Director, Washington DC VA Medical Center, and co-investigator in the research. “The current study demonstrates how VA researchers can use VA data to provide timely information to Veterans and the nation.”

“The unprecedented controversy about the harmful effect of hydroxychloroquine on heart rhythm was generated after the drug was temporarily approved for COVID-19 during early periods of the pandemic. However, it caused unnecessary concerns and confusion among patients and clinicians alike,” said Charles Faselis, MD, Chief of Staff, Washington DC VA Medical Center, and Professor of Medicine at George Washington University and Uniformed Services University, Washington, DC, who is also the lead investigator in the research. “We received numerous calls from concerned Veterans with lupus and rheumatoid arthritis asking whether they need to stop taking their hydroxychloroquine. At that time, clinicians did not have information to provide a specific answer, and now, findings from our study offer new evidence, based on nationwide data from Veterans with rheumatoid arthritis, that hydroxychloroquine is safe.”

“Rheumatologists have long known hydroxychloroquine to be a safe drug, even in pregnant women. Findings from the current study now provide new information that will reassure patients and clinicians alike that there is no need to discontinue or withhold hydroxychloroquine due to concerns for adverse cardiovascular effects,” said Gail Kerr, MD, Chief of Rheumatology at the Washington DC VA Medical Center, and Professor of Medicine at Howard and Georgetown Universities, and a co-investigator in the study.

“The long QT syndrome, the heart problem most commonly linked to hydroxychloroquine, is potentially dangerous as it can lead to sudden death, but fortunately it is extremely rare in the general population, and findings from the current study suggest that it is equally rare in patients taking hydroxychloroquine”, said Hans Moore, MD, Chief of Cardiology at the Washington DC VA Medical Center and Professor of Medicine at Georgetown University, George Washington University and Uniformed Services University, Washington, DC, who is a co-investigator in the study. Dr. Moore is also the Associate Director of VA’s National Cardiac Device Surveillance Program.

“What we have learned from this study is that if 10,000 patients taking hydroxychloroquine are followed for a year, five may develop long QT syndrome, and 68 may be hospitalized for irregular heart rhythm – these are extremely low numbers, and importantly these numbers are similar to those taking other DMRAD-type drugs,” said Qing Zeng-Treitler, PhD, Co-Director of the Center for Data Science and Outcomes Research, Washington DC VA Medical Center, and Professor and Director, Biomedical Informatics Center at George Washington University, who co-led this study with Dr. Faselis.

“There is no randomized controlled trial or well-done observational study of hydroxychloroquine in patients with rheumatoid arthritis. Findings from our study show that using large electronic health record data and emulating the design of a randomized trial, researchers can provide timely evidence to fill in important knowledge gaps that can improve care”, said Ali Ahmed, MD, MPH, Associate Chief of Staff for Health and Aging, Washington DC VA Medical Center, and Professor of Medicine at George Washington University and Georgetown University, and the study’s senior investigator.

In rheumatoid arthritis, the body’s immune system attacks cells in the body, leading to inflammation and damage to joints which causes pain, deformity and loss of function. Hydroxychloroquine, originally used to treat malaria, now plays a central role in the treatment of rheumatoid arthritis. It is known as a DMARD or disease-modifying anti-rheumatic drug because it not only improves symptoms but also modifies the underlying disease.

Drs. Faselis, Zeng, and their colleagues studied 8,852 Veteran patients with rheumatoid arthritis – 4,426 started on hydroxychloroquine, and 4,426 started on another DMARD. Patients in the two groups were similar on 87 baseline characteristics, including duration of their rheumatoid arthritis.

These Veteran patients received care in the VA healthcare system around the country between October 1, 1999 and December 31, 2020. The study was funded by Washington DC VA Medical Center, and many study investigators are supported by research awards from VA's Health Services Research and Development (HSR&D). However, the content of this research is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs or the Washington DC VA Medical Center.

Other co-authors in the study are Qing Zeng-Treitler, PhD; Yan Cheng, PhD; David J. Nashel, MD; Angelike Liappis, MD; Amy C. Weintrob, MD; Pamela E. Karasik, MD; Cherinne Arundel, MD; Denise Boehm, RN; Michael S. Heimall, MHA, MSS, FACHE; Daniel Taub, PhD; Yijun Shao, PhD; Douglas Redd, PhD; Helen M. Sheriff, MD; Sijian Zhang, MB MS, MPH; Ross D. Fletcher, MD; and Hans J. Moore, MD from the Washington DC VA Medical Center; Lawrence B. Connell, MS, from the Veterans Affairs Medical Center, Providence, RI; Gregg C. Fonarow, MD, from University of California, Los Angeles; and Douglas Redd, PhD, who passed away on June 24, 2020.

To coordinate an interview with one of the researchers of the Washington DC VA Medical Center, please contact Gloria Hairston, Director, Office of Public Affairs, 202-603-1585.

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