Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19

Konig, Maximilian F.; Kim, Alfred H.J.; Scheetz, Marc H.; Graef, Elizabeth R.; Liew, David; Simard, Julia F.; Machado, Pedro; Gianfrancesco, Milena; Yazdany, Jinoos; Langguth, Daman; Robinson, Philip C

doi:10.1136/annrheumdis-2020-217690

Cited by 70 publications

(84 citation statements)

References 22 publications

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“…Importantly, some medications used to treat rheumatic diseases, such as hydroxychloroquine and interleukin-6 (IL-6) inhibitors, are being studied for the prevention and/or treatment of COVID-19 and its complications including cytokine-storm. [2][3][4] At present, the implications of COVID-19 for people living with rheumatic diseases remain poorly understood.…”

Section: Epidemiologymentioning

confidence: 99%

Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

et al. 2020

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ObjectivesCOVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease.MethodsCase series of individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed.ResultsA total of 600 cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% CI 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively). Non-steroidal anti-inflammatory drug (NSAID) use was not associated with hospitalisation status (OR 0.64, 95% CI 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed.ConclusionsWe found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalisation.

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Section: Epidemiologymentioning

confidence: 99%

Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

et al. 2020

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“…The registry has also provided preliminary data on 80 SLE-patients with COVID-19 and the use of HCQ. Sixty-four percent of the SLE-patients were taking antimalarials prior to the infection with SARS-CoV-2 and admission frequency to the hospital did not differ between HCQ users and non-users [55% (16/29) vs. 57% (29/51), p = ns; χ 2 -test] ( 60 ). This argues against a protective role of HCQ (in the usually administered dose for RMD patients) in SARS-CoV-2 infection, which is also supported by pharmacological in vitro data describing a much higher level needed for effective viral inhibition ( 61 ).…”

Section: Rheumatic Diseases and Covid-19mentioning

confidence: 99%

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

et al. 2020

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In December 2019, a cluster of severe pneumonia was observed in China, with the subsequent discovery of a new beta-coronavirus (SARS-CoV-2) as the causative agent. The elicited disease COVID-19 is characterized by fever, dry cough, myalgia, or fatigue and has a favorable outcome in the majority of cases. However, in some patients COVID-19 leads to severe pneumonia and sepsis with subsequent respiratory failure and gastrointestinal, hematological, neurological, and cardiovascular complications. A higher risk of infection is intrinsic to active rheumatic and musculoskeletal diseases (RMD) and the use of biological disease modifying anti-rheumatic drugs (DMARDs). With an increasing number of reports on COVID-19 in RMD patients, we are beginning to appraise their risks. In this review, we summarize the published cases of COVID-19 infections in RMD patients, including patients with inflammatory arthritis and connective tissue diseases as well as anti-phospholipid syndrome and Kawasaki syndrome. Overall, patients with inflammatory arthritis do not seem to be at a higher risk for infection or a severe course of COVID-19. Risk for critical COVID-19 in patients with systemic inflammatory diseases such as SLE or vasculitis might be increased, but this needs further confirmation. Furthermore, we summarize the data on DMARDs used to fight SARS-CoV-2 infection and hyperinflammation.

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“…Data collected through the COVID-19 Global Rheumatology Alliance registry recently confirmed that patients with lupus on baseline therapy with HCQ are not universally protected from COViD-19 5. Therefore, we commend Favalli et al to emphasise the primordial role of physical distancing and the adoption of strict rules for the prevention of contagion, because of the uncertain protection of patients with SLE from severe SARS-CoV-2 infection by HCQ treatment.…”

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confidence: 96%

Response to: ‘Are patients with systemic lupus erythematosus at increased risk for COVID-19?’ by Favalliet al

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Amoura

2020

Ann Rheum Dis

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Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19

Cited by 70 publications

References 22 publications

Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

Response to: ‘Are patients with systemic lupus erythematosus at increased risk for COVID-19?’ by Favalliet al

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