TY  - JOUR
PY  - 2020//
TI  - Risk of depression, suicide and psychosis with hydroxychloroquine treatment for  rheumatoid arthritis: a multinational network cohort study
JO  - Rheumatology (Oxford)
A1  - Lane, Jennifer C. E.
A1  - Weaver, James
A1  - Kostka, Kristin
A1  - Duarte-Salles, Talita
A1  - Abrahao, Maria Tereza F.
A1  - Alghoul, Heba
A1  - Alser, Osaid
A1  - Alshammari, Thamir M.
A1  - Areia, Carlos
A1  - Biedermann, Patricia
A1  - Banda, Juan M.
A1  - Burn, Edward
A1  - Casajust, Paula
A1  - Fister, Kristina
A1  - Hardin, Jill
A1  - Hester, Laura
A1  - Hripcsak, George
A1  - Kaas-Hansen, Benjamin Skov
A1  - Khosla, Sajan
A1  - Kolovos, Spyros
A1  - Lynch, Kristine E.
A1  - Makadia, Rupa
A1  - Mehta, Paras P.
A1  - Morales, Daniel R.
A1  - Morgan-Stewart, Henry
A1  - Mosseveld, Mees
A1  - Newby, Danielle
A1  - Nyberg, Fredrik
A1  - Ostropolets, Anna
A1  - Woong Park, Rae
A1  - Prats-Uribe, Albert
A1  - Rao, Gowtham A.
A1  - Reich, Christian
A1  - Rijnbeek, Peter
A1  - Sena, Anthony G.
A1  - Shoaibi, Azza
A1  - Spotnitz, Matthew
A1  - Vignesh, Subbian
A1  - Suchard, Marc A.
A1  - Vizcaya, David
A1  - Wen, Haini
A1  - de Wilde, Marcel
A1  - Xie, Junqing
A1  - You, Seng Chan
A1  - Zhang, Lin
A1  - Lovestone, Simon
A1  - Ryan, Patrick
A1  - Prieto-Alhambra, Daniel
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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>
LA  - en
SN  - 1462-0324
UR  - http://dx.doi.org/10.1093/rheumatology/keaa771
ID  - ref1
ER  -