Risk of depression, suicide and psychosis with hydroxychloroquine treatment for rheumatoid arthritis: a multinational network cohort study.
Objectives Concern has been raised in the rheumatology community regarding recent regulatory warnings that HCQ used in the coronavirus disease 2019 pandemic could cause acute psychiatric events. We aimed to study whether there is risk of incident depression, suicidal ideation or psychosis associated...
| Publicado en: | Rheumatology Vol. 60; no. 7; pp. 3222 - 3235 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Oxford University Press / USA
Jul2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=151354267&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 151354267 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14620324 DN9 jtl: Rheumatology issn: 14620324 maglogo: N pubinfo: dt: Jul2021 vid: 60 iid: 7 pid: 622 pub: Oxford University Press / USA artinfo: ui: 151354267 151354267 151354267 10.1093/rheumatology/keaa771 151354267 ppf: 3222 ppct: 13 formats: tig: atl: Risk of depression, suicide and psychosis with hydroxychloroquine treatment for rheumatoid arthritis: a multinational network cohort study. aug: au: Lane, Jennifer C E Weaver, James Kostka, Kristin Duarte-Salles, Talita Abrahao, Maria Tereza F Alghoul, Heba Alser, Osaid Alshammari, Thamir M Areia, Carlos Biedermann, Patricia Banda, Juan M Burn, Edward Casajust, Paula Fister, Kristina Hardin, Jill Hester, Laura Hripcsak, George Kaas-Hansen, Benjamin Skov Khosla, Sajan Kolovos, Spyros affil: Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford , Oxford, UK sug: subj: Hydroxychloroquine Adverse Effects Arthritis, Rheumatoid Drug Therapy Depression Risk Factors Suicidal Ideation Risk Factors Psychotic Disorders Risk Factors Risk Assessment Sulfasalazine Therapeutic Use Human Prospective Studies Billing and Claims Electronic Health Records Germany United Kingdom United States Hydroxychloroquine Therapeutic Use Cox Proportional Hazards Model Confidence Intervals Descriptive Statistics Comparative Studies ab: Objectives Concern has been raised in the rheumatology community regarding recent regulatory warnings that HCQ used in the coronavirus disease 2019 pandemic could cause acute psychiatric events. We aimed to study whether there is risk of incident depression, suicidal ideation or psychosis associated with HCQ as used for RA. Methods We performed a new-user cohort study using claims and electronic medical records from 10 sources and 3 countries (Germany, UK and USA). RA patients ≥18 years of age and initiating HCQ were compared with those initiating SSZ (active comparator) and followed up in the short (30 days) and long term (on treatment). Study outcomes included depression, suicide/suicidal ideation and hospitalization for psychosis. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate database-specific calibrated hazard ratios (HRs), with estimates pooled where I2 <40%. Results A total of 918 144 and 290 383 users of HCQ and SSZ, respectively, were included. No consistent risk of psychiatric events was observed with short-term HCQ (compared with SSZ) use, with meta-analytic HRs of 0.96 (95% CI 0.79, 1.16) for depression, 0.94 (95% CI 0.49, 1.77) for suicide/suicidal ideation and 1.03 (95% CI 0.66, 1.60) for psychosis. No consistent long-term risk was seen, with meta-analytic HRs of 0.94 (95% CI 0.71, 1.26) for depression, 0.77 (95% CI 0.56, 1.07) for suicide/suicidal ideation and 0.99 (95% CI 0.72, 1.35) for psychosis. Conclusion HCQ as used to treat RA does not appear to increase the risk of depression, suicide/suicidal ideation or psychosis compared with SSZ. No effects were seen in the short or long term. Use at a higher dose or for different indications needs further investigation. Trial registration Registered with EU PAS (reference no. EUPAS34497; http://www.encepp.eu/encepp/viewResource.htm? id=34498). The full study protocol and analysis source code can be found at https://github.com/ohdsi-studies/Covid19EstimationHydroxychloroquine2. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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