HYDROXYCHLOROQUINE IN HAND OA; RESULTS OF THE UK HERO TRIAL

Kingsbury, S. R.; Tharmanathan, P.; Keding, A.; Ronaldson, S.; Grainger, A.; Wakefield, R.; Arundel, C.; Birrell, F.; Doherty, M.; Vincent, T.; Watt, F. E.; Dziedzic, K.; O'Neill, T.; Arden, N.; Scott, D. L.; Dickson, J.; Garrood, T.; Green, M.; Menon, A.; Sheeran, T.; Torgerson, D.; Conaghan, P. G.

Abstract

Purpose: Symptomatic hand osteoarthritis (OA) represents a considerable economic, clinical and social burden, and has limited treatment options. Synovitis is prevalent in OA and associated with pain. Hydroxychloroquine (HCQ) is used routinely for treating synovitis in inflammatory arthritides such as rheumatoid arthritis. The primary aim of the HERO RCT was to determine the effectiveness of HCQ as an analgesic treatment for hand OA, and secondarily to determine if synovitis was associated with treatment response, effects on structural progression and cost-effectiveness.

Methods: Symptomatic hand osteoarthritis (OA) represents a considerable economic, clinical and social burden, and has limited treatment options. Synovitis is prevalent in OA and associated with pain. Hydroxychloroquine (HCQ) is used routinely for treating synovitis in inflammatory arthritides such as rheumatoid arthritis. The primary aim of the HERO RCT was to determine the effectiveness of HCQ as an analgesic treatment for hand OA, and secondarily to determine if synovitis was associated with treatment response, effects on structural progression and cost-effectiveness.

Results: Follow-up was 84.7% at 6 months and 76.6% at 12 months. The mean initial HCQ dose for the intervention arm (n= 114) was 320 mg. At the primary endpoint, the treatment difference estimate between HCQ and Placebo was -0.16 points on the NRS pain scale (95% CI: -0.72 to 0.41, p=0.584, Table 1). There were no significant treatment differences at 3, 6 or 12 months for any secondary outcomes including radiographic outcomes (Table 1). Baseline structural damage did not affect response to HCQ. On ultrasound, 94% had ≥1 joint positive for greyscale

synovitis, 59% were Power Doppler positive; synovitis did not impact on treatment group differences. The economic analysis found that HCQ was less costly but produced a smaller quality-adjusted life year (QALY) gain than placebo, saving £6,545 per QALY lost, and was not considered to be cost-effective.

Conclusions: HCQ was not more effective than placebo in reducing symptoms or radiographic progression in people selected for moderate to severe hand pain and radiographic OA; HCQ is therefore not recommended for this patient group. Given the analgesic benefits of other anti-inflammatory therapies, these findings may reflect the mild anti-inflammatory action of HCQ, differing drug effects on certain OA pathologies, and also inclusion criteria in hand OA trials, where ultrasound-synovitis may not be as prevalent as in knee OA.

Citation

Kingsbury, S. R., Tharmanathan, P., Keding, A., Ronaldson, S., Grainger, A., Wakefield, R., …Conaghan, P. G. (2017). HYDROXYCHLOROQUINE IN HAND OA; RESULTS OF THE UK HERO TRIAL. Osteoarthritis and Cartilage, 25(S1), S3-S4. https://doi.org/10.1016/j.joca.2017.02.012

• Journal Article Type: Conference Paper
• Online Publication Date: Apr 18, 2017
• Publication Date: 2017-04
• Deposit Date: Oct 17, 2023
• Journal: OSTEOARTHRITIS AND CARTILAGE
• Print ISSN: 1063-4584
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: S1
• Pages: S3-S4
• DOI: https://doi.org/10.1016/j.joca.2017.02.012
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1063458417300614