Rheumatoid Arthritis: Hydroxychloroquine Use Not Linked to Increased Risk of Psychiatric Events

Sarfaroj Khan 


December 31, 2020


Why this matters

  • Findings do not support stopping HCQ for RA based on concerns raised in patients with COVID-19.

Study design

  • A new-user cohort study included patients with RA who initiated HCQ (n=918,144) and SSZ (n=290,383; active comparator), identified using claims and electronic medical records from 10 sources and 3 countries (Germany, UK and USA).

  • Associations between short-term (30 days) and long-term (on treatment) use of HCQ (vs SSZ use) and risk of depression, suicide/suicidal ideation and psychosis were evaluated.

  • Funding: National Institute for Health Research Oxford Biomedical Research Centre and others.

Key results

  • In the short-term analysis, no consistent association was seen between the risk of psychiatric events and HCQ use (vs SSZ use), with meta-analytic HRs (95% CI) of:

    • 0.96 (0.79-1.16) for depression;

    • 0.94 (0.49-1.77) for suicide/suicidal ideation; and

    • 1.03 (0.66-1.60) for psychosis.

  • Findings were similar in the long-term analysis, with meta-analytic HRs (95% CI) of:

    • 0.94 (0.71-1.26) for depression;

    • 0.77 (0.56-1.07) for suicide/suicidal ideation; and

    • 0.99 (0.72-1.35) for psychosis.


  • There may have been an overlap of patients across datasets.


Lane JCE, Weaver J, Kostka K, Duarte-Salles T, Abrahao MTF, Alghoul H, Alser O, Alshammari TM, Areia C, Biedermann P, Banda JM, Burn E, Casajust P, Fister K, Hardin J, Hester L, Hripcsak G, Kaas-Hansen BS, Khosla S, Kolovos S, Lynch KE, Makadia R, Mehta PP, Morales DR, Morgan-Stewart H, Mosseveld M, Newby D, Nyberg F, Ostropolets A, Woong Park R, Prats-Uribe A, Rao GA, Reich C, Rijnbeek P, Sena AG, Shoaibi A, Spotnitz M, Vignesh S, Suchard MA, Vizcaya D, Wen H, de Wilde M, Xie J, You SC, Zhang L, Lovestone S, Ryan P, Prieto-Alhambra D. Risk of depression, suicide and psychosis with hydroxychloroquine treatment for rheumatoid arthritis: a multinational network cohort study. Rheumatology (Oxford). 2020 Dec 25 [Epub ahead of print]. doi: 10.1093/rheumatology/keaa771. PMID: 33367863 View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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