Revisiting cardiac safety of hydroxychloroquine in rheumatological diseases during COVID-19 era: Facts and myths

Abstract

Severe acute respiratory syndrome coronavirus 2 has spread across the globe affecting more than 10 million people as of August 2020. With the pandemic spreading at such an alarming rate, a lot of effortsare in the process of identification of an effective treatment at it's earliest. Hydroxychloroquine (HCQ) issuch a drug that is being studied as a repurposed agent, although the early results are still inconclusive.However, an important adverse effect that has raised concerns in the recent times is its possible cardiactoxicity, mainly the 'QT,' prolongation in electro-cardiogram, which has created a sense of apprehensionfor its use in traditional indications like rheumatological conditions. In decades of HCQ use by rheumatologists, this cardiac toxicity was rarely ever seen. So, what is different in the current coronavirus disease 2019(COVID-19) era? This review outlines various studies on HCQ reporting cardiac adverse events in patientswith rheumatic diseases as well as, in patients with COVID-19 infection. In addition, two important observations were noticed; first, the doses that have been used in the current COVID-19 scenario are muchhigher than what are used in rheumatology. Second, COVID-19 infection may by itself lead to intrinsiccardiac abnormalities, which is probably acting as a confounder. Most of the available and credible datasuggest that HCQ is a safe drug, including the RECOVERY trial stating no cardiotoxicity by HCQ. This reviewreinforces the safety profile of HCQ in a data-driven manner and addresses the concerns of the physicians.However, its cautious use in those with pre-existing cardiac abnormalities cannot be overemphasized.