Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis
Identifieur interne : 000035 ( Hal/Checkpoint ); précédent : 000034; suivant : 000036Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis
Auteurs : Claire Rempenault [France] ; Bernard Combe [France] ; Thomas Barnetche [France] ; Cécile Gaujoux-Viala [France] ; Cédric Lukas [France] ; Jacques Morel [France] ; Charlotte Hua [France]Source :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2018.
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Abstract
OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Hydroxychloroquine (HCQ) has been shown to improve survival rates in other inflammatory diseases. We aimed to assess the available literature on the cardiovascular impact of HCQ in patients with RA. METHODS: We systematically searched for studies evaluating the effects of HCQ on cardiovascular outcomes of known risk factors for CVD in patients with RA. Databases searched were MEDLINE (via PubMed), EMBase, Cochrane Library and the American College of Rheumatology and European League Against Rheumatism annual meetings. A meta-analysis was performed with a random-effects model, estimating mean differences (MDs), HRs and 95% CIs. Data were extracted by one investigator and independently checked by another. RESULTS: The literature search revealed 185 articles and abstracts of interest; further examination resulted in 16 studies fulfilling the criteria. The MDs between HCQ users and non-users in levels of total, low-density and high-density cholesterol and triglycerides were -9.8 (95% CI -14.0 to -5.6), -10.6 (95% CI -14.2 to -7.0), +4.1 (95% CI 2.2 to 6.0) and -19.2 (95% CI -27.2 to -11.1), respectively. Diabetes incidence was lower for HCQ ever users than never users (HR 0.59 (95% CI 0.49 to 0.70)). HCQ seemed to decrease insulin resistance and incidence of CVD, but data were too few for meta-analysis. CONCLUSION: Besides its limited efficacy for disease activity and progression, HCQ may benefit the metabolic profile and to a lesser extent cardiovascular events in patients with RA, which suggests its usefulness combined with other conventional synthetic disease-modifying antirheumatic drugs.
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DOI: 10.1136/annrheumdis-2017-211836
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systematic review and meta-analysis</title><author><name sortKey="Rempenault, Claire" sort="Rempenault, Claire" uniqKey="Rempenault C" first="Claire" last="Rempenault">Claire Rempenault</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-53275" status="VALID"> <orgName>Département de Rhumatologie[Montpellier]</orgName> <desc> <address> <addrLine>371, avenue du Doyen Gaston Giraud 34295 Montpellier cedex 5</addrLine> <country key="FR"></country> </address> </desc> <listRelation> <relation active="#struct-258773" type="direct"></relation> <relation active="#struct-300154" type="direct"></relation> </listRelation> <tutelles><tutelle active="#struct-258773" type="direct"><org type="institution" xml:id="struct-258773" status="VALID"> <orgName>Centre Hospitalier Régional Universitaire [Montpellier]</orgName> <orgName type="acronym">CHRU Montpellier</orgName> <desc> <address> <addrLine>191 avenue du doyen Gaston Giraud 34295 Montpellier cedex 5</addrLine> 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sort="Lukas, Cedric" uniqKey="Lukas C" first="Cédric" last="Lukas">Cédric Lukas</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-53275" status="VALID"> <orgName>Département de Rhumatologie[Montpellier]</orgName> <desc> <address> <addrLine>371, avenue du Doyen Gaston Giraud 34295 Montpellier cedex 5</addrLine> <country key="FR"></country> </address> </desc> <listRelation> <relation active="#struct-258773" type="direct"></relation> <relation active="#struct-300154" type="direct"></relation> </listRelation> <tutelles><tutelle active="#struct-258773" type="direct"><org type="institution" xml:id="struct-258773" status="VALID"> <orgName>Centre Hospitalier Régional Universitaire [Montpellier]</orgName> <orgName type="acronym">CHRU Montpellier</orgName> <desc> <address> <addrLine>191 avenue du doyen Gaston Giraud 34295 Montpellier cedex 5</addrLine> <country key="FR"></country> </address> <ref type="url">http://www.chu-montpellier.fr</ref> </desc> </org></tutelle><tutelle active="#struct-300154" type="direct"><org type="institution" xml:id="struct-300154" status="INCOMING"> <orgName>Hôpital Lapeyronie</orgName> <desc> <address> <country key="FR"></country> </address> </desc> </org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author><author><name sortKey="Morel, Jacques" sort="Morel, Jacques" uniqKey="Morel J" first="Jacques" last="Morel">Jacques Morel</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-53275" status="VALID"> <orgName>Département de Rhumatologie[Montpellier]</orgName> <desc> <address> <addrLine>371, avenue du Doyen Gaston Giraud 34295 Montpellier cedex 5</addrLine> <country key="FR"></country> </address> </desc> <listRelation> <relation active="#struct-258773" type="direct"></relation> <relation active="#struct-300154" type="direct"></relation> </listRelation> <tutelles><tutelle active="#struct-258773" type="direct"><org type="institution" 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<addrLine>371, avenue du Doyen Gaston Giraud 34295 Montpellier cedex 5</addrLine> <country key="FR"></country> </address> </desc> <listRelation> <relation active="#struct-258773" type="direct"></relation> <relation active="#struct-300154" type="direct"></relation> </listRelation> <tutelles><tutelle active="#struct-258773" type="direct"><org type="institution" xml:id="struct-258773" status="VALID"> <orgName>Centre Hospitalier Régional Universitaire [Montpellier]</orgName> <orgName type="acronym">CHRU Montpellier</orgName> <desc> <address> <addrLine>191 avenue du doyen Gaston Giraud 34295 Montpellier cedex 5</addrLine> <country key="FR"></country> </address> <ref type="url">http://www.chu-montpellier.fr</ref> </desc> </org></tutelle><tutelle active="#struct-300154" type="direct"><org type="institution" xml:id="struct-300154" status="INCOMING"> <orgName>Hôpital Lapeyronie</orgName> <desc> <address> <country key="FR"></country> </address> </desc> </org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author></analytic><idno type="DOI">10.1136/annrheumdis-2017-211836</idno><series><title level="j">Annals of the Rheumatic Diseases</title><idno type="ISSN">0003-4967</idno><imprint><date type="datePub">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="mix" xml:lang="en"><term>Antirheumatic Agents</term><term>Arthritis</term><term>Cardiovascular Diseases</term><term>Cholesterol</term><term>DMARDs (synthetic)</term><term>HDL</term><term>Humans</term><term>Hydroxychloroquine</term><term>LDL</term><term>Metabolic Diseases</term><term>Minimal Clinically Important Difference</term><term>Rheumatoid</term><term>Risk Factors</term><term>Triglycerides</term><term>cardiovascular disease</term><term>rheumatoid arthritis</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"> <p>OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Hydroxychloroquine (HCQ) has been shown to improve survival rates in other inflammatory diseases. We aimed to assess the available literature on the cardiovascular impact of HCQ in patients with RA. METHODS: We systematically searched for studies evaluating the effects of HCQ on cardiovascular outcomes of known risk factors for CVD in patients with RA. Databases searched were MEDLINE (via PubMed), EMBase, Cochrane Library and the American College of Rheumatology and European League Against Rheumatism annual meetings. A meta-analysis was performed with a random-effects model, estimating mean differences (MDs), HRs and 95% CIs. Data were extracted by one investigator and independently checked by another. RESULTS: The literature search revealed 185 articles and abstracts of interest; further examination resulted in 16 studies fulfilling the criteria. The MDs between HCQ users and non-users in levels of total, low-density and high-density cholesterol and triglycerides were -9.8 (95% CI -14.0 to -5.6), -10.6 (95% CI -14.2 to -7.0), +4.1 (95% CI 2.2 to 6.0) and -19.2 (95% CI -27.2 to -11.1), respectively. Diabetes incidence was lower for HCQ ever users than never users (HR 0.59 (95% CI 0.49 to 0.70)). HCQ seemed to decrease insulin resistance and incidence of CVD, but data were too few for meta-analysis. CONCLUSION: Besides its limited efficacy for disease activity and progression, HCQ may benefit the metabolic profile and to a lesser extent cardiovascular events in patients with RA, which suggests its usefulness combined with other conventional synthetic disease-modifying antirheumatic drugs.</p> </div></front></TEI><hal api="V3"> <titleStmt> <title xml:lang="en">Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis</title> <author role="aut"> <persName> <forename type="first">Claire</forename> <surname>Rempenault</surname> </persName> <idno type="halauthorid">11290958</idno> <affiliation ref="#struct-53275"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Bernard</forename> <surname>Combe</surname> </persName> <idno type="halauthorid">253663</idno> <affiliation ref="#struct-53275"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Thomas</forename> <surname>Barnetche</surname> </persName> <idno type="halauthorid">1100476</idno> <affiliation ref="#struct-300122"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Cécile</forename> <surname>Gaujoux-Viala</surname> </persName> <idno type="halauthorid">819601</idno> <affiliation ref="#struct-361498"></affiliation> <affiliation ref="#struct-95060"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Cédric</forename> <surname>Lukas</surname> </persName> <idno type="halauthorid">970952</idno> <affiliation ref="#struct-53275"></affiliation> <affiliation ref="#struct-95060"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Jacques</forename> <surname>Morel</surname> </persName> <idno type="halauthorid">474053</idno> <affiliation ref="#struct-53275"></affiliation> <affiliation ref="#struct-712"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Charlotte</forename> <surname>Hua</surname> </persName> <idno type="halauthorid">11195294</idno> <affiliation ref="#struct-53275"></affiliation> </author> <editor role="depositor"> <persName> <forename>pascale</forename> <surname>roussel</surname> </persName> <email type="md5">1692bb2fa6c060a2d7d0a4566573a94c</email> <email type="domain">umontpellier.fr</email> </editor> </titleStmt> <editionStmt> <edition n="v1" type="current"> <date type="whenSubmitted">2019-11-06 11:09:15</date> <date type="whenModified">2019-11-07 01:30:31</date> <date type="whenReleased">2019-11-06 11:09:15</date> <date type="whenProduced">2018</date> </edition> <respStmt> <resp>contributor</resp> <name key="561022"> <persName> <forename>pascale</forename> <surname>roussel</surname> </persName> <email type="md5">1692bb2fa6c060a2d7d0a4566573a94c</email> <email type="domain">umontpellier.fr</email> </name> </respStmt> </editionStmt> <publicationStmt> <distributor>CCSD</distributor> <idno type="halId">hal-02350944</idno> <idno type="halUri">https://hal.archives-ouvertes.fr/hal-02350944</idno> <idno type="halBibtex">rempenault:hal-02350944</idno> <idno type="halRefHtml">Annals of the Rheumatic Diseases, BMJ Publishing Group, 2018, 77 (1), pp.98--103. ⟨10.1136/annrheumdis-2017-211836⟩</idno> <idno type="halRef">Annals of the Rheumatic Diseases, BMJ Publishing Group, 2018, 77 (1), pp.98--103. ⟨10.1136/annrheumdis-2017-211836⟩</idno> </publicationStmt> <seriesStmt> <idno type="stamp" n="CNRS">CNRS - Centre national de la recherche scientifique</idno> <idno type="stamp" n="MIPS">Mathématiques, Informatique, Physique et Systèmes</idno> <idno type="stamp" n="BS">Biologie-Santé</idno> <idno type="stamp" n="UNIV-MONTPELLIER">Université de Montpellier</idno> <idno type="stamp" n="IGMM">Institut de génétique moléculaire de Montpellier</idno> </seriesStmt> <notesStmt> <note type="audience" n="2">International</note> <note type="popular" n="0">No</note> <note type="peer" n="1">Yes</note> </notesStmt> <sourceDesc> <biblStruct> <analytic> <title xml:lang="en">Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis</title> <author role="aut"> <persName> <forename type="first">Claire</forename> <surname>Rempenault</surname> </persName> <idno type="halauthorid">11290958</idno> <affiliation ref="#struct-53275"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Bernard</forename> <surname>Combe</surname> </persName> <idno type="halauthorid">253663</idno> <affiliation ref="#struct-53275"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Thomas</forename> <surname>Barnetche</surname> </persName> <idno type="halauthorid">1100476</idno> <affiliation ref="#struct-300122"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Cécile</forename> <surname>Gaujoux-Viala</surname> </persName> <idno type="halauthorid">819601</idno> <affiliation ref="#struct-361498"></affiliation> <affiliation ref="#struct-95060"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Cédric</forename> <surname>Lukas</surname> </persName> <idno type="halauthorid">970952</idno> <affiliation ref="#struct-53275"></affiliation> <affiliation ref="#struct-95060"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Jacques</forename> <surname>Morel</surname> </persName> <idno type="halauthorid">474053</idno> <affiliation ref="#struct-53275"></affiliation> <affiliation ref="#struct-712"></affiliation> </author> <author role="aut"> <persName> <forename type="first">Charlotte</forename> <surname>Hua</surname> </persName> <idno type="halauthorid">11195294</idno> <affiliation ref="#struct-53275"></affiliation> </author> </analytic> <monogr> <idno type="halJournalId" status="VALID">10511</idno> <idno type="issn">0003-4967</idno> <idno type="eissn">1468-2060</idno> <title level="j">Annals of the Rheumatic Diseases</title> <imprint> <publisher>BMJ Publishing Group</publisher> <biblScope unit="volume">77</biblScope> <biblScope unit="issue">1</biblScope> <biblScope unit="pp">98--103</biblScope> <date type="datePub">2018</date> </imprint> </monogr> <idno type="doi">10.1136/annrheumdis-2017-211836</idno> <idno type="pubmed">28970215</idno> </biblStruct> </sourceDesc> <profileDesc> <langUsage> <language ident="en">English</language> </langUsage> <textClass> <keywords scheme="author"> <term xml:lang="en">HDL</term> <term xml:lang="en">cardiovascular disease</term> <term xml:lang="en">Triglycerides</term> <term xml:lang="en">Hydroxychloroquine</term> <term xml:lang="en">LDL</term> <term xml:lang="en">Risk Factors</term> <term xml:lang="en">Cholesterol</term> <term xml:lang="en">rheumatoid arthritis</term> <term xml:lang="en">Antirheumatic Agents</term> <term xml:lang="en">Cardiovascular Diseases</term> <term xml:lang="en">Rheumatoid</term> <term xml:lang="en">Arthritis</term> <term xml:lang="en">Humans</term> <term xml:lang="en">DMARDs (synthetic)</term> <term xml:lang="en">Metabolic Diseases</term> <term xml:lang="en">Minimal Clinically Important Difference</term> </keywords> <classCode scheme="halDomain" n="sdv">Life Sciences [q-bio]</classCode> <classCode scheme="halTypology" n="ART">Journal articles</classCode> </textClass> <abstract xml:lang="en"> <p>OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Hydroxychloroquine (HCQ) has been shown to improve survival rates in other inflammatory diseases. We aimed to assess the available literature on the cardiovascular impact of HCQ in patients with RA. METHODS: We systematically searched for studies evaluating the effects of HCQ on cardiovascular outcomes of known risk factors for CVD in patients with RA. Databases searched were MEDLINE (via PubMed), EMBase, Cochrane Library and the American College of Rheumatology and European League Against Rheumatism annual meetings. A meta-analysis was performed with a random-effects model, estimating mean differences (MDs), HRs and 95% CIs. Data were extracted by one investigator and independently checked by another. RESULTS: The literature search revealed 185 articles and abstracts of interest; further examination resulted in 16 studies fulfilling the criteria. The MDs between HCQ users and non-users in levels of total, low-density and high-density cholesterol and triglycerides were -9.8 (95% CI -14.0 to -5.6), -10.6 (95% CI -14.2 to -7.0), +4.1 (95% CI 2.2 to 6.0) and -19.2 (95% CI -27.2 to -11.1), respectively. Diabetes incidence was lower for HCQ ever users than never users (HR 0.59 (95% CI 0.49 to 0.70)). HCQ seemed to decrease insulin resistance and incidence of CVD, but data were too few for meta-analysis. CONCLUSION: Besides its limited efficacy for disease activity and progression, HCQ may benefit the metabolic profile and to a lesser extent cardiovascular events in patients with RA, which suggests its usefulness combined with other conventional synthetic disease-modifying antirheumatic drugs.</p> </abstract> </profileDesc> </hal></record>Pour manipuler ce document sous Unix (Dilib)
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