@article{6e38ec18976c4ee08b6343ee5dc11ef9,
title = "Hydroxychloroquine and maintenance immunosuppression use in kidney transplant recipients: Analysis of linked US registry and claims data",
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.",
keywords = "hydroxychloroquine, immunosuppression, kidney transplantation, outcomes, pharmacy claims, registries, scleroderma, systemic lupus erythematosus",
author = "Lentine, {Krista L.} and Lam, {Ngan N.} and Yasar Caliskan and Tarek Alhamad and Huiling Xiao and Schnitzler, {Mark A.} and Chang, {Su Hsin} and David Axelrod and Segev, {Dorry L.} and Mara McAdams-DeMarco and Kasiske, {Bertram L.} and Hess, {Gregory P.} and Brennan, {Daniel C.}",
note = "Funding Information: This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). The US Government (and others acting on its behalf) retains a paid‐up, nonexclusive, irrevocable, worldwide license for all works produced under the SRTR contract, and to reproduce them, prepare derivative works, distribute copies to the public, and perform publicly and display publicly, by or on behalf of the Government. KLL, MAS, DLS, MMD, GPH received support from a grant from National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01‐DK120518. KLL receives support from the Mid‐America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR, the US Government, or the funding sources. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. Funding Information: This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). The US Government (and others acting on its behalf) retains a paid-up, nonexclusive, irrevocable, worldwide license for all works produced under the SRTR contract, and to reproduce them, prepare derivative works, distribute copies to the public, and perform publicly and display publicly, by or on behalf of the Government. KLL, MAS, DLS, MMD, GPH received support from a grant from National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01-DK120518. KLL receives support from the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR, the US Government, or the funding sources. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. Publisher Copyright: {\textcopyright} 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",
year = "2020",
month = dec,
doi = "10.1111/ctr.14118",
language = "English",
volume = "34",
journal = "Clinical Transplantation",
issn = "0902-0063",
number = "12",
}