Journal article
Hydroxychloroquine and maintenance immunosuppression use in kidney transplant recipients: Analysis of linked US registry and claims data
Clinical transplantation, Vol.34(12), pp.e14118-n/a
12/2020
DOI: 10.1111/ctr.14118
PMID: 33048372
Abstract
Hydroxychloroquine (HCQ) is an antimalarial drug with immunomodulatory effects used to treat systemic lupus erythematosus (SLE) and scleroderma. The antiviral effects of HCQ have raised attention in the context of the COVID-19 pandemic, although safety is controversial. We examined linkages of national transplant registry data with pharmaceutical claims and Medicare billing claims to study HCQ use among Medicare-insured kidney transplant recipients with SLE or scleroderma (2008-2017; N = 1820). We compared three groups based on immunosuppression regimen 7 months-to-1 year post transplant: (a) tacrolimus (Tac) + mycophenolic acid (MPA) + prednisone (Pred) (referent group, 77.7%); (b) Tac + MPA + Pred + HCQ (16.5%); or (c) other immunosuppression + HCQ (5.7%). Compared to the referent group, recipients treated with other immunosuppression + HCQ had a 2-fold increased risk of abnormal ECG or QT prolongation (18.9% vs. 10.7%; aHR,
1.96
, p = .02) and ventricular arrhythmias (15.2% vs. 11.4%; aHR,
1.81
, p = .05) in the >1-to-3 years post-transplant. Tac + MPA + Pred + HCQ was associated with increased risk of ventricular arrhythmias (13.5% vs. 11.4%; aHR,
1.54
, p = .04) and pancytopenia (35.9% vs. 31.4%; aHR,
1.31
, p = .03) compared to triple immunosuppression without HCQ. However, HCQ-containing regimens were not associated with an increased risk of death or graft failure. HCQ may be used safely in selected kidney transplant recipients in addition to their maintenance immunosuppression, although attention to arrhythmias is warranted.
Details
- Title: Subtitle
- Hydroxychloroquine and maintenance immunosuppression use in kidney transplant recipients: Analysis of linked US registry and claims data
- Creators
- Krista L Lentine - Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USANgan N Lam - University of CalgaryYasar Caliskan - Saint Louis UniversityTarek Alhamad - Washington University in St. LouisHuiling Xiao - Saint Louis UniversityMark A Schnitzler - Saint Louis UniversitySu-Hsin Chang - Washington University in St. LouisDavid Axelrod - University of IowaDorry L Segev - Saint Louis UniversityMara McAdams-DeMarco - Johns Hopkins UniversityBertram L Kasiske - Hennepin CountyGregory P Hess - Drexel UniversityDaniel C Brennan - Johns Hopkins University
- Resource Type
- Journal article
- Publication Details
- Clinical transplantation, Vol.34(12), pp.e14118-n/a
- DOI
- 10.1111/ctr.14118
- PMID
- 33048372
- ISSN
- 0902-0063
- eISSN
- 1399-0012
- Grant note
- HHSH250201000018C / HRSA HHS R01-DK120518 / NIDDK NIH HHS
- Language
- English
- Date published
- 12/2020
- Academic Unit
- Surgery
- Record Identifier
- 9984322804302771
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