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Hydroxychloroquine (HCQ) is revered in the rheumatology community as being one of the safest conventional synthetic DMARDs. It is versatile -- used in connective tissue disorders and inflammatory arthritis -- an easy adjunct therapy, and safe for use in child-bearing, pregnant, and breast-feeding patients. In recent years there has been a lot of discussion regarding its influence on cardiovascular disease given the drug's propensity for prolonged QT.

In a study in , Aviña-Zubieta et al. sought to evaluate the risk of incident arrhythmias in a population of patients receiving and those not receiving HCQ. They concluded that HCQ does not increase risk of incident arrhythmias.

Subgroups analyzed included patients with RA and SLE. Patients with history of arrhythmia or on arrhythmogenic medications were excluded. Arrhythmias were defined as any new and unspecified arrhythmias, atrial fibrillation, and abnormal electrocardiogram -- including prolonged QT syndrome and conduction disorders. 11,518 hydroxychloroquine initiators and 11,518 non-initiators were included after 1:1 propensity score matching. Median duration of HCQ use was 1.9 years. HCQ initiators were younger, and included more patients with SLE with lower prevalence of comorbid conditions.

During an 8-year follow-up, 1,610 HCQ initiators and 1,646 not on HCQ developed incidental arrhythmia. The hazard ratio was similar for both groups of patients in regard to incidence of arrhythmias.

This study, based in British Columbia, Canada, identified no difference in risk of arrhythmia in HCQ initiators and HCQ non-initiators. It was well powered. It would be helpful to understand the frequency of arrhythmias in elderly population, those with pre-existing structural cardiac abnormalities and/or pre-existing arrhythmias, and whether dosing of HCQ played a role in arrhythmias.

Overall this study helps support the notion that HCQ is a safe option for patients.

Sneha Patel, MD, practices rheumatology in Ft Worth, Texas.

Read the study here and a Q&A with a study coauthor here.