Session Information
Session Type: Poster Session D
Session Time: 8:30AM-10:30AM
Background/Purpose: Hydroxychloroquine (HCQ) is one of the widely used immunomodulator in rheumatology. Its temporary trendy use during the early phase of COVID pandemic stresses its short-term QT prolonging effect on COVID 19 patients. Many patients with autoimmune diseases have concurrent fibromyalgia or depression or psychiatric disorder that will require them to be on other chronic medication with potential QT prolongation effect. To clarify if HCQ or other medications is the culprit for prolonging QTc, we looked at the QTc prolongation effect in patients specifically not on other QT prolonging medications.
Methods: All adult patients, age >18 years, from Jan 2015 to Dec 2020 followed at SUNY Upstate Medical University who were prescribed HCQ were included in the study.
Results: 9484 patients were treated with HCQ, of which only 3917 were on HCQ without other QT prolonging medications (anti depression, antipsychotics, antiarrhythmics), among which 1036 patients had 1 EKG done, and 635 had 2 EKG done. Among the patients only on HCQ as potential QT prolong medications with 2 EKGs, only 68 patients had 1 EKG done before HCQ and 1 EKG done after HCQ initiation. Among these patients, 13 patients had prolonged QTc ( >460ms) on their first EKG, and 7 remained to have prolonged QTc on repeat, 6 patients with initial long QTc had normal QTc on repeat; 16 patients had prolonged QTc on their 2nd EKG, 9 were new from normal QTc on initial EKG, shown as table below.
| Number of patients on HCQ | 9484 |
| Number of patients on HCQ as only QT prolonging medication | 3917 |
| Number of patients on HCQ as only QT prolonging medication with 1 EKG | 1036 |
| Number of patients on HCQ as only QT prolonging medication with 2 EKG | 635 |
| Number of patients on HCQ as only QT prolonging medication with EKG done before and after initiation of HCQ | 68 |
| long QTc on 1st EKG | QTc remain long on 2ndEKG | QT normal on 2ndEKG |
| 13 | 7 | 6 |
| long QTc on 2nd EKG | QTc long on 1st EKG | QTc normal on 1stEKG |
| 16 | 7 | 9 |
Conclusion: HCQ causing prolongation is a well-known drug effect, however routine EKG screening before starting HCQ is not done. This project showed that it is very common for patients on HCQ to be simultaneously on other QT prolonging medication chronically which may potentially have add-on effect. For those patients on HCQ only with EKG to compare before and after, this project was unable to show the QTc prolongation effect on HCQ, but this may be due to limited available samples.
To cite this abstract in AMA style:
Wang H. Hydroxychloroquine Alone Does Not Increase QTc in the Absence of Other QT-prolonging Medications [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/hydroxychloroquine-alone-does-not-increase-qtc-in-the-absence-of-other-qt-prolonging-medications/. Accessed .« Back to ACR Convergence 2021
ACR Meeting Abstracts - https://acrabstracts.org/abstract/hydroxychloroquine-alone-does-not-increase-qtc-in-the-absence-of-other-qt-prolonging-medications/