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Farhat H, Kassab CJ, Tlaiss Y, Gutlapalli SD, Ganipineni VDP, Paramsothy J, Tedesco S, Kailayanathan T, Abdulaal R, Otterbeck P. Hydroxychloroquine and the associated risk of arrhythmias. Glob Cardiol Sci Pract 2024; 2024:e202417. [PMID: 38746066 PMCID: PMC11090172 DOI: 10.21542/gcsp.2024.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/14/2024] [Indexed: 05/16/2024] Open
Abstract
Hydroxychloroquine (HCQ), which was initially used as an antimalarial drug, is now being used to treat other illnesses, especially rheumatic autoimmune disorders such as systemic lupus erythematosus, primary Sjögren's syndrome, and rheumatoid arthritis, because it is safe, effective, and cost efficient. This drug has shown high efficacy and has become the first-line treatment for many of these diseases. Although HCQ has many therapeutic effects, it has unfortunately shown some complications, especially with its long-term use. One of these side effects is arrhythmia through prolongation of the QT interval. This narrative literature review focuses on the effects of HCQ on the QT interval in patients with rheumatologic diseases who have been prescribed this drug. In particular, we will focus on the increased risk of arrhythmia when HCQ is administered with other drugs, such as azithromycin and many others, along with drug-drug interactions. In addition, we investigated the safety of this drug in pregnant women.
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Affiliation(s)
- Hadi Farhat
- Internal Medicine, University of Balamand, Beirut, Lebanon
| | - Celine J. Kassab
- Pharmacy, Lebanese American University School of Pharmacy, Beirut, Lebanon
| | - Yehya Tlaiss
- Internal Medicine, University of Balamand, Beirut, Lebanon
| | - Sai Dheeraj Gutlapalli
- Internal Medicine, Richmond University Medical Center Mount Sinai, Staten Island, New York, USA
| | | | - Jananthan Paramsothy
- Internal Medicine, Richmond University Medical Center Mount Sinai, Staten Island, New York, USA
| | - Sarah Tedesco
- Psychiatry, Richmond University Medical Center Mount Sinai, Staten Island, New York, USA
| | - Tharunjan Kailayanathan
- Internal Medicine, Richmond University Medical Center Mount Sinai, Staten Island, New York, USA
| | | | - Philip Otterbeck
- Internal Medicine, Richmond University Medical Center Mount Sinai, Staten Island, New York, USA
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Al-Abdulkarim H, Sharma Y, Attar SM, Husain W, Al-Homood I, Al Omari B, Mohamed O, Alsaqa'aby M, Jaheen AM, Anwar A, Hamad TM, Alzahrani Z. Cost-effectiveness analysis of upadacitinib as a treatment option for patients with rheumatoid arthritis in the Kingdom of Saudi Arabia. J Med Econ 2024; 27:134-144. [PMID: 38163926 DOI: 10.1080/13696998.2023.2299176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
AIM To evaluate cost-effectiveness of upadacitinib (targeted synthetic-disease modifying anti-rheumatic drug [ts-DMARD]) as first-line (1 L) treatment versus current treatment among patients with rheumatoid arthritis (RA) in the Kingdom of Saudi Arabia (KSA), who had an inadequate response to prior conventional-synthetic (csDMARDs) and/or biologic-DMARDs (bDMARDs). METHODS This Excel-based model included patients with moderate (Disease Activity Score [DAS28]: >3.2 to ≤5.1) or severe RA (DAS28 > 5.1). Cost-effectiveness of current treatment (1 L: adalimumab-originator/biosimilar; second-line (2 L): other bDMARDs/tofacitinib) was compared against a new treatment involving two scenarios (1 L: upadacitinib, 2 L: adalimumab-biosimilar [scenario-1]/adalimumab-originator [scenario-2]) for a 10-year time-horizon from societal perspective. Model outcomes included direct and indirect costs, quality-adjusted life-years (QALYs), hospitalization days, number of orthopedic surgeries, and incremental cost-utility ratio (ICUR) per QALY. RESULTS With the current pathway, estimated total societal costs for 100 RA patients over 10-year period were Saudi Riyal (SAR) 50,450,354 (United States dollars [USD] 13,453,428) (moderate RA) and SAR50,013,945 (USD13,337,052) (severe RA). New pathway (scenario-1) showed that in patients with moderate-to-severe RA, upadacitinib led to higher QALY gain (+8.99 and +15.63) at lower societal cost (cost difference: -SAR2,023,522 [-USD539,606] and -SAR3,373,029 [-USD899,474], respectively). Thus, as 1 L, upadacitinib projects "dominant" ICUR per QALY over current pathway. Moreover, in alternate pathway (scenario-2), upadacitinib also projects "dominant" ICUR per QALY for patient with severe RA (QALY gain: +15.63; cost difference: -SAR 164,536 [-USD43,876]). However, moderate RA was associated with additional cost of SAR1,255,696 (USD334,852) for improved QALY (+8.99) over current pathway (ICUR per QALY: SAR139,742 [USD37,264]). Both scenarios resulted in reduced hospitalization days (scenario-1: -14.83 days; scenario-2: -11.41 days) and number of orthopedic surgeries (scenario-1: -8.36; scenario-2: -6.54) for moderate-to-severe RA over the current treatment pathway. CONCLUSION Upadacitinib as 1 L treatment in moderate-to-severe RA can considerably reduce healthcare resource burden in KSA, majorly due to reduced drug administration/monitoring/hospitalization/surgical and indirect costs.
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Affiliation(s)
- Hana Al-Abdulkarim
- National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
| | | | - Suzan M Attar
- Rheumatology & Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Ibrahim Al-Homood
- Internal Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Bedor Al Omari
- Pharmaceutical Care Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omneya Mohamed
- Real-World Evidence (RWE), IQVIA AG, Dubai, United Arab Emirates
| | - Mai Alsaqa'aby
- Real-World Evidence (RWE), IQVIA Solutions, Riyadh, Saudi Arabia
| | - Ahmed M Jaheen
- Branch of AbbVie Biopharmaceuticals GmbH, Scientific Office, Riyadh, Saudi Arabia
| | - Ali Anwar
- Branch of AbbVie Biopharmaceuticals GmbH, Scientific Office, Riyadh, Saudi Arabia
| | - Tharwat M Hamad
- Branch of AbbVie Biopharmaceuticals GmbH, Scientific Office, Riyadh, Saudi Arabia
| | - Zeyad Alzahrani
- Department of Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Alotaibi AM, Albahdal AS, Abanmy N, Alwhaibi M, Asiri Y, AlRuthia Y. Health-related quality of life of patients with rheumatoid arthritis on tocilizumab, adalimumab, and etanercept in Saudi Arabia: a single-center cross-sectional study. Front Pharmacol 2023; 14:1299630. [PMID: 38161694 PMCID: PMC10757325 DOI: 10.3389/fphar.2023.1299630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose: The aim of this study was to assess the quality of life (QOL) of patients with rheumatoid arthritis (RA) on tocilizumab versus other commonly used monoclonal antibodies (mAbs) (e.g., adalimumab and etanercept). Methods: This was an interview-based cross-sectional study. Adult RA patients (≥18 years) with a disease duration of at least 1 year were included in the study. The Arabic version of EUROQOL (EQ-5D-5L) was used to assess the QOL of RA patients on mAbs. Multiple linear regression was conducted to examine the impact of tocilizumab versus other mAbs on the visual analog scale (VAS) score controlling for age, disease duration, treatment duration, gender, number of comorbidities, and the use of steroids. Results: The number of patients who met the inclusion criteria and consented to be interviewed was 105 patients (tocilizumab (n = 37), adalimumab (n = 31), and etanercept (n = 37)). No significant differences in the scores of the five EQ-5D-5L domains across different mAbs was found. Although the VAS score of patients on tocilizumab was numerically higher compared to their counterparts on adalimumab or etanercept (69.19 vs. 62.79) this was not statistically significant controlling for age, gender, disease and treatment durations, number of comorbidities, and the utilization of steroids (β = 4.26, 95% CI: [-8.84-17.36], p = 0.52). Conclusion: The use of tocilizumab did not seem to result in better QOL among RA patients. Future studies with larger sample sizes and more robust designs should be conducted to confirm or refute these findings.
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Affiliation(s)
- Amjad M. Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Areej S. Albahdal
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Norah Abanmy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Yousif Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Khabsa J, Yaacoub S, Omair MA, Al Rayes H, Akl EA. Methodology for the adolopment of recommendations for the treatment of rheumatoid arthritis in the Kingdom of Saudi Arabia. BMC Med Res Methodol 2023; 23:224. [PMID: 37817088 PMCID: PMC10563247 DOI: 10.1186/s12874-023-02031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Currently, there are no guidelines for the treatment of rheumatoid arthritis (RA) tailored to the context of the Kingdom of Saudi Arabia (KSA). Adaptation of guidelines accounts for contextual factors and becomes more efficient than de novo guideline development when relevant, good quality, and up-to-date guidelines are available. The objective of this study is to describe the methodology used for the adolopment of the 2021 American College of Rheumatology (ACR) guidelines for the treatment of RA in the KSA. METHODS We followed the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE)-ADOLOPMENT methodology. The adolopment KSA panel included relevant stakeholders and leading contributors to the original guidelines. We developed a list of five adaptation-relevant prioritization criteria that the panelists applied to the original recommendations. We updated the original evidence profiles with newly published studies identified by the panelists. We constructed Evidence to Decision (EtD) tables including contextual information from the KSA setting. We used the PanelVoice function of GRADEPro Guideline Development Tool (GDT) to obtain the panel's judgments on the EtD criteria ahead of the panel meeting. Following the meeting, we used the PANELVIEW instrument to obtain the panel's evaluation of the process. RESULTS The KSA panel prioritized five recommendations, for which one evidence profile required updating. Out of five adoloped recommendations, two were modified in terms of direction, and one was modified in terms of certainty of the evidence. Criteria driving the modifications in direction were valuation of outcomes, balance of effects, cost, and acceptability. The mean score on the 7-point scale items of the PANELVIEW instrument had an average of 6.47 (SD = 0.18) across all items. CONCLUSION The GRADE-ADOLOPMENT methodology proved to be efficient. The panel assessed the process and outcome positively. Engagement of stakeholders proved to be important for the success of this project.
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Affiliation(s)
- Joanne Khabsa
- AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Yaacoub
- AUB Grade Center, American University of Beirut Medical Center, Beirut, Lebanon
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed A. Omair
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hanan Al Rayes
- Division of Rheumatology, Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Riad-El-Solh, P.O. Box: 11-0236, Beirut, 1107 2020 Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON Canada
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