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Cardiovascular safety of hydroxychloroquine: Brief appraisal of data

Hydroxychloroquine (HCQ), widely used in rheumatology since decades and in type 2 diabetes (T2D) since 2014, has garnered special attention in the current pandemic caused by SARS-CoV-2. HCQ appears to be effective in early COVID-19 and prophylaxis, and more studies are ongoing; its efficacy in severe disease is unclear. Few studies evaluating usage of HCQ in patients hospitalized with COVID-19 have raised concerns about the cardiovascular safety of HCQ, particularly QT-prolongation. It is important to understand the distinct clinical settings where HCQ is being used and appraise the data on cardiac effects of this commonly used drug. Although COVID-19 is an acute pro-arrhythmogenic state, HCQ is extensively used in patients with chronic inflammatory conditions such as rheumatoid arthritis, lupus, and T2D. In these indications, data from clinical studies, real-world experiences, and exhaustive pharmacovigilance database inspires confidence and suggests the cardiac side-effects of HCQ to be rare in frequency. The physicians and patients using HCQ in approved indications at recommended doses need to be reassured of its clinical importance and risk-benefit profile.