Effect of chronic hydroxychloroquine use on COVID-19 risk in patients with rheumatoid arthritis and systemic lupus erythematosus: a multicenter retrospective cohort

Walbi, Ismail A.; Albarqi, Hassan A.; Alghanim, N.; Albadi, Marzooq A; Maimouni, Hesham Mohammed Al; Alkahtani, Saad A.; Alshabi, Ali Mohamed; Alali, Amer S.; Alqahtani, Faleh; Al-Najjar, Amal Hassan; Hazzazi, Mohammad A; Alanazi, Deemah Sattam; Sabei, Abdulrahman Abdulaziz; Alsaweed, Omer S; Alajra, Rahaf K; Alqhtani, Hussain

doi:10.1177/03000605221090363

Cited by 7 publications

(6 citation statements)

References 32 publications

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“…15 16 19 We found no evidence that hydroxychloroquine increased or reduced the risk of COVID-19 infection. This is consistent with the findings of Walbi et al 20 In our cohort, we did not observe a significantly lower rate of incident infection in vaccinated patients during the more recent phases of the pandemic. This is consistent with the limited efficacy of the vaccine against the Omicron variant as reported by Andrews et al 21 Our study has some limitations.…”

Section: Discussionsupporting

confidence: 94%

Does the use of corticosteroids and immunosuppressants increase the risk of COVID-19 infection among people with systemic lupus erythematosus?

Magder,

Fava,

Goldman

et al. 2023

Lupus Sci Med

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ObjectiveAn important clinical question is whether the use of immunosuppressants or corticosteroids increases the risk of incident COVID-19 disease among patients with SLE. To address this question, we examined the incidence of COVID-19 infection in a large SLE cohort.MethodsThis study was based on a single-centre cohort of patients with SLE seen quarterly from March 2020 to August 2022. Clinical information from these visits was augmented with information on COVID-19 infections and vaccinations obtained from the electronic medical records and by patient self-report. We compared treated and untreated patients with respect to the incidence of COVID-19 infection per person month. Statistical significance was assessed based on logistic regression models.ResultsWe observed 339 incident cases of COVID-19 experienced over 24 614 person-months of follow-up from 1052 different patients. The risk of infection per person-month of follow-up was similar among those not on prednisone (1.37%), on moderate doses of prednisone (<7 mg/day) (1.44%) and those on higher doses (1.52%) (p=0.87 for difference). We observed an elevated risk among those taking belimumab, however, after adjustment for potential confounding variables, the increased risk was not statistically significant (rate ratio 1.4, 95% CI 0.88 to 2.24, p=0.16) There was no evidence of an increased risk among those taking mycophenolate, methotrexate or azathioprine.ConclusionIt is reassuring that there was not strong evidence of an increased risk of infection among those taking prednisone or other immunosuppressants. However, given the range of our CIs, moderate effects of these medications on COVID-19 risk cannot be completely ruled out.

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Section: Discussionsupporting

confidence: 94%

Does the use of corticosteroids and immunosuppressants increase the risk of COVID-19 infection among people with systemic lupus erythematosus?

Magder,

Fava,

Goldman

et al. 2023

Lupus Sci Med

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“…We found no difference in drug frequency between the CInf and CuInf groups which agreed with findings of other groups. 4,6,18,19 It, however, disagrees with a meta-analysis of seven studies conducted by Akiyama et al showing COVID-19 was significantly higher in patients with autoimmune disease including SLE than control being attributable mainly to the use of steroids. 20 Due to the strict low dose steroid policy at our institute, SLE patients are usually kept on steroid sparing agents and only low levels of steroids are used.…”

Section: Discussionmentioning

confidence: 83%

Characteristics of SLE patients with symptomatic COVID-19: Single centre experience at Sultan Qaboos University Hospital over a 30-month period

Hassan

Lawati

Rizvi

2023

Lupus

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Background COVID-19 pandemic was declared by WHO in March 2020. Severity of disease varied from asymptomatic to fatal infection. Severe disease was found to be associated with hyperinflammation syndrome. Systemic lupus erythematosus (SLE) is treated with various immunosuppressive agents, intensity of which depends on the severity of the disease. We aimed to study the characteristic of SLE patients infected with COVID-19. Methods 352 patients with SLE were included in this observational cross-section study conducted over a 30-month period beginning from 24th February 2020 (first COVID cases documented in Oman) until end of July 2022. Data were retrieved from electronic medical records and through questionnaire handed to patients in OPD or filled through phone calls. Results 40.6% of SLE patients developed COVID-19 infection with mean age of 37 years and maintaining their male to female ratio as in SLE disease. Majority of the patients in both COVID-infected and non-infected groups had SLE disease activity of zero. Sore throat and cough were present in almost all patients. Other common symptoms were myalgia/arthralgia (94%) followed by fever. Significant difference between the groups was in severity of SLE and in lung involvement. No difference was noted between the two groups in other parameters including regarding the frequency of medication. Conclusions This is the first study of COVID-19 in SLE patients in the Gulf Council Countries (GCCs). A significant difference between COVID-infected and uninfected groups was seen in the SLE disease activity and whether lung was involved in the SLE patients. We found no impact for DM, HTN, BMI, IHD, lupus nephrites of SLE medication on COVID-19 infection.

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“…A total of 63 studies were fully screened for inclusion. After the evaluation of exclusion criteria, 20 manuscripts remained and were included in the meta-analysis [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41].…”

Section: Search Resultsmentioning

confidence: 99%

“…There was a considerably lower incidence of hospitalization due to COVID-19 infection in patients with chronic HCQ/CQ use (186/767; 24.3%) compared to the other group without chronic use of HCQ/CQ (447/1581; 28.3%); (12 studies; OR 0.80; 95% CI 0.65-0.99; p = 0.04; I 2 = 0%; Figure 3). [23,24,[26][27][28][29][30]32,33,[37][38][39].…”

Section: Hospitalizationmentioning

confidence: 99%

COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and Meta-Analysis

Amêndola

Pinheiro

Póvoa

et al. 2022

JCM

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The ongoing chronic use of hydroxychloroquine or chloroquine (HCQ/CQ) in rheumatic patients might impact their outcomes after a SARS-CoV-2 infection. Therefore, we sought to assess the mortality in rheumatic patients with chronic HCQ/CQ use who developed a COVID-19 infection through a comparison between individuals chronically using HCQ/CQ with those not taking these drugs. We performed a systematic review and meta-analysis of studies on PubMed, Embase, and Cochrane Central. We included full-length reports, prospective observational cohorts, and clinical trials of adult patients (aged ≥ 18 years) who were diagnosed with a COVID-19 infection. Case studies, case series, letters, comments, and editorials were excluded. The main outcome was all-cause mortality. This study is registered with PROSPERO (CRD42022341678). We identified 541 studies, of which 20 studies were included, comprising 236,997 patients. All-cause mortality was significantly lower in patients with prior chronic use of HCQ/CQ compared to those with no previous usage (OR 0.76; 95% CI 0.62–0.94; p = 0.01). There was a considerably lower incidence of hospitalization among patients with chronic HCQ/CQ use compared to their counterparts without HCQ/CQ usage (OR 0.80; 95% CI 0.65–0.99; p = 0.04). All-cause mortality and hospitalization were significantly lower in rheumatic patients with chronic HCQ/CQ use who developed a COVID-19 infection.

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Effect of chronic hydroxychloroquine use on COVID-19 risk in patients with rheumatoid arthritis and systemic lupus erythematosus: a multicenter retrospective cohort

Cited by 7 publications

References 32 publications

Does the use of corticosteroids and immunosuppressants increase the risk of COVID-19 infection among people with systemic lupus erythematosus?

Does the use of corticosteroids and immunosuppressants increase the risk of COVID-19 infection among people with systemic lupus erythematosus?

Characteristics of SLE patients with symptomatic COVID-19: Single centre experience at Sultan Qaboos University Hospital over a 30-month period

COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and Meta-Analysis

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