News in brief: Hydroxychloroquine CV risk minimal in RA patients; New Cochrane conclusions on treatments for gout tophi; Fake data leads to flawed thinking on vitamin D and falls

Wednesday, 18 Aug 2021

Hydroxychloroquine CV risk minimal in RA patients

Hydroxychloroquine (HCQ) use in rheumatoid arthritis (RA) patients is associated with minimal cardiovascular risk in non-COVID-19-affected patients, a new study shows.

American researchers reviewed cardiovascular outcomes in 8,852 US veterans who were newly diagnosed with RA and started on HCQ or nonbiologic disease-modifying antirheumatic drugs (DMARDs) between 2001 and 2017, after observational studies linked an increased risk of cardiovascular events and mortality with HCQ use in hospitalised COVID-19 patients.

The new study identified three long QT syndrome events, 56 arrhythmia-related hospitalisations and 280 all-cause deaths — two, 30 (hazard ratio associated with HCQ: 1.16, 95% CI: 0.68–1.95]) and 144 (HR associated with HCQ: 1.06, 95% CI: 0.84–1.34]) of which were in HCQ patients, respectively — at one year follow-up, the authors wrote in Arthritis & Rheumatology.

“Our findings indicate that the incidence of long QT syndrome and arrhythmia-related hospitalisation is low in patients with RA during the first year after the initiation of HCQ or another non-biologic DMARD,” they wrote.

“We found no evidence that HCQ therapy is associated with a higher risk of adverse cardiovascular events or death.”

Yet, study limitations, including lack of echocardiogram use, a mostly-male population inconsistent with the demographic distribution of RA, and relatively short follow-up time, “should give clinicians pause in their desire to be entirely reassured by the findings,” Associate Professor Candace Feldman and Professor Mark Link wrote in an accompanying commentary.

“Overall, the results of this methodologically rigorous study suggest that HCQ administration among patients with RA is unlikely to be associated with a significant enough risk to dissuade clinicians from continuing to safely prescribe the medication.”

“However, additional studies are essential to guide strategies for monitoring of QTc intervals, and to identify individuals at significantly higher risk of adverse outcomes for whom clinicians may consider avoiding HCQ.”

New Cochrane conclusions on treatments for gout tophi

An updated Cochrane review has provided new recommendations on treatment of tophi with urate‐lowering drugs such as lesinurad and febuxostat.

The new systematic review included four more trials compared to the previous one done in 2014 and reaffirmed previous findings that there was Moderate‐certainty evidence showed that pegloticase is probably beneficial for resolution of tophi in gout.

In new conclusions, the review noted that lesinurad 400 mg plus febuxostat may be beneficial for tophi resolution (compared with lesinurad 200 mg plus febuxostat).

However, the reviewers concluded that lesinurad plus allopurinol was probably not beneficial for tophi resolution, and said there was a need for further randomised controlled trial (RCT) evidence for all other urate‐lowering therapies as well as surgical interventions such as decompression and debridement.

Fake data leads to flawed thinking on vitamin D and falls

The debate on whether vitamin D is good for muscle strength has been skewed by fake data, even long after it has been retracted according to an editorial in the Journal of Bone and Mineral Research.

Professor Roger Bouillon of the Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium, writes that a new systematic review of high-quality placebo-controlled studies shows that vitamin D supplementation has no effects on muscle strength or mass and may even increase risk of falls.

The new review was done after a few (“positive”) studies were withdrawn due to fabrication of data, but the perception remained that vitamin D supplementation may be generally beneficial for muscle and bone health, he said

“The wisest decision is probably to correct or prevent vitamin D deficiency while avoiding intermittent boluses or daily doses higher than the upper limit recommended by the Institute of Medicine (IOM) or the European Food Safety Authority (EFSA) (4000 IU/day) because such doses may also have a negative effect on bone density,” he suggested.

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