Journal article
Hydroxychloroquine and maintenance immunosuppression use in kidney transplant recipients: Analysis of linked US registry and claims data
Clinical transplantation, v 34(12), e14118
01 Dec 2020
PMID: 33048372
Featured in Collection : UN Sustainable Development Goals @ Drexel
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,1.121.963.42, p = .02) and ventricular arrhythmias (15.2% vs. 11.4%; aHR,1.001.813.29, 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,1.021.542.31, p = .04) and pancytopenia (35.9% vs. 31.4%; aHR,1.031.311.68, 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.
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Details
- Title
- 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, United StatesNgan N. Lam - University of AlbertaYasar Caliskan - Saint Louis UniversityTarek Alhamad - Washington University in St. LouisHuiling Xiao - Saint Louis UniversityMark A. Schnitzler - Saint Louis UniversitySu Hsin Chang - Washington University in Saint Louis, St. Louis, MO, United StatesDavid Axelrod - University of IowaDorry L. Segev - Johns Hopkins UniversityMara McAdams-DeMarco - Johns Hopkins UniversityBertram L. Kasiske - Hennepin County Medical CenterGregory P. Hess - Drexel University, Philadelphia, PA, United StatesDaniel C. Brennan - Johns Hopkins Medicine
- Publication Details
- Clinical transplantation, v 34(12), e14118
- Grant note
- HHSH250201000018C / Health Resources and Services Administration (100000102) SRTR R01-DK120518 / National Institute of Diabetes and Digestive and Kidney Diseases (100000062) R01DK120518 / National Institute of Diabetes and Digestive and Kidney Diseases (http://data.elsevier.com/vocabulary/SciValFunders/100000062) Government of South Australia (http://data.elsevier.com/vocabulary/SciValFunders/100015015) National Institutes of Health (http://data.elsevier.com/vocabulary/SciValFunders/100000002) U.S. Department of Health and Human Services (http://data.elsevier.com/vocabulary/SciValFunders/100000016) HHSH250201000018C / Hennepin Healthcare Research Institute (http://data.elsevier.com/vocabulary/SciValFunders/100017245) Health Resources and Services Administration (http://data.elsevier.com/vocabulary/SciValFunders/100000102)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000591171200001
- Scopus ID
- 2-s2.0-85096699513
- Other Identifier
- 991021860767104721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Surgery
- Transplantation