@article{ref1,
title="Risk of depression, suicide and psychosis with hydroxychloroquine treatment for  rheumatoid arthritis: a multinational network cohort study",
journal="Rheumatology (Oxford)",
year="2020",
author="Lane, Jennifer C. E. and Weaver, James and Kostka, Kristin and Duarte-Salles, Talita and Abrahao, Maria Tereza F. and Alghoul, Heba and Alser, Osaid and Alshammari, Thamir M. and Areia, Carlos and Biedermann, Patricia and Banda, Juan M. and Burn, Edward and Casajust, Paula and Fister, Kristina and Hardin, Jill and Hester, Laura and Hripcsak, George and Kaas-Hansen, Benjamin Skov and Khosla, Sajan and Kolovos, Spyros and Lynch, Kristine E. and Makadia, Rupa and Mehta, Paras P. and Morales, Daniel R. and Morgan-Stewart, Henry and Mosseveld, Mees and Newby, Danielle and Nyberg, Fredrik and Ostropolets, Anna and Woong Park, Rae and Prats-Uribe, Albert and Rao, Gowtham A. and Reich, Christian and Rijnbeek, Peter and Sena, Anthony G. and Shoaibi, Azza and Spotnitz, Matthew and Vignesh, Subbian and Suchard, Marc A. and Vizcaya, David and Wen, Haini and de Wilde, Marcel and Xie, Junqing and You, Seng Chan and Zhang, Lin and Lovestone, Simon and Ryan, Patrick and Prieto-Alhambra, Daniel",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="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. <br><br>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%. <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="1462-0324",
doi="10.1093/rheumatology/keaa771",
url="http://dx.doi.org/10.1093/rheumatology/keaa771"
}