Potential Shortages of Hydroxychloroquine for Patients with Lupus During the Coronavirus Disease 2019 Pandemic

Mehta, Bella; Salmon, Jane E.; Ibrahim, Said A.

doi:10.1001/jamahealthforum.2020.0438

Cited by 43 publications

(24 citation statements)

References 6 publications

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“…Amongst SLE-comorbidities we found a high prevalence of hypertension, which was associated with cCOVID-19 as previously reported. Notably, no clear association was found between HCQ and absolute protection from COVID-19, in line with a very recent report [35] , although the concomitant use of immunosuppressants in 61% of the responders might have affected these results and masked some potential effects of HCQ in contrasting factors such as dysregulated inflammation with impaired pathogen clearance and enhanced interferon-mediated responses which might potentiate SARS-CoV-2 virulence [ 16 , 46 ]. Also, it is not possible to exclude that somehow HCQ might have mitigated the course of COVID-19 in these patients: indeed our questionnaire did not address the severity of COVID-19 course, which could have been differentially expressed under distinct treatment regimens.…”

Section: Discussionsupporting

confidence: 64%

COVID-19 in systemic lupus erythematosus: Data from a survey on 417 patients

Ramirez

Gerosa

Beretta

et al. 2020

Seminars in Arthritis and Rheumatism

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Background: Systemic lupus erythematosus (SLE) is a chronic disease characterised by autoimmunity and increased susceptibility to infections. COVID-19 is a systemic viral disease currently spreading as a pandemic. Little is known about the impact of COVID-19 in patients with SLE. Objective: to acquire information on the impact of COVID-19 in SLE. Methods: A 26-item anonymous questionnaire investigating demographics, SLE clinical features, COVID-19 diagnoses and changes in treatments and daily habits was administered to patients with SLE from three referral centres through www.surveymonkey.com over 10 days. Data from the survey were compared to those from published estimates about the general population. Results: Four-hundred-seventeen patients responded to the survey. More than 60% of subjects complained of symptoms that are also associated to COVID-19. Fourteen COVID-19 diagnoses (five confirmed by polymerase chain reaction) were reported, in contrast to a 0.73% prevalence of confirmed cases in Lombardy. One hospitalisation was reported. Fever, anosmia, dry cough, a self-reported history of neuropsychiatric SLE and a recent contact with confirmed COVID-19 cases were more strongly associated with COVID-19, as were symptoms and lower compliance to behavioural preventive measures in patients' contacts. No protective effect was seen in subjects on hydroxychloroquine. Conclusion: COVID-19 morbidity might only moderately be increased in most patients with SLE, although limited information can be inferred on more severe cases. Hydroxychloroquine apparently seems not to confer protection to infection per se, although other beneficial roles cannot be excluded. Containment policies and behavioural preventive measures could have a major role in limiting the impact of COVID-19 in patients with SLE.

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Section: Discussionsupporting

confidence: 64%

COVID-19 in systemic lupus erythematosus: Data from a survey on 417 patients

Ramirez

Gerosa

Beretta

et al. 2020

Seminars in Arthritis and Rheumatism

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“…The original published article has since been retracted after researchers were unable to verify the reliability of their results [ 33 ]. Regardless, President Trump tweeted his support for hydroxychloroquine as “one of the biggest game changers in the history of medicine” [ 34 ], causing panic about medication shortages, particularly from those with systemic lupus erythematosus for which it is the first-line therapy [ 35 ]. Due to off-label prescriptions and hoarding practices, difficulties accessing hydroxychloroquine have been reported globally [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Due to off-label prescriptions and hoarding practices, difficulties accessing hydroxychloroquine have been reported globally [ 36 ]. Hydroxychloroquine shortages pose a threat to the health and safety of people with inflammatory arthritis, with reports that many will experience flare-ups and may develop irreversible organ damage without their regular dose [ 35 ]. Our findings highlight the need for accurate information about treatments and their effectiveness and the critical role that clinicians play in dispelling myths and inaccuracies during times of rapidly changing information.…”

Section: Discussionmentioning

confidence: 99%

Tweets by People With Arthritis During the COVID-19 Pandemic: Content and Sentiment Analysis

Berkovic¹,

Ackerman²,

Briggs³

et al. 2020

J Med Internet Res

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Background Emerging evidence suggests that people with arthritis are reporting increased physical pain and psychological distress during the COVID-19 pandemic. At the same time, Twitter’s daily usage has surged by 23% throughout the pandemic period, presenting a unique opportunity to assess the content and sentiment of tweets. Individuals with arthritis use Twitter to communicate with peers, and to receive up-to-date information from health professionals and services about novel therapies and management techniques. Objective The aim of this research was to identify proxy topics of importance for individuals with arthritis during the COVID-19 pandemic, and to explore the emotional context of tweets by people with arthritis during the early phase of the pandemic. Methods From March 20 to April 20, 2020, publicly available tweets posted in English and with hashtag combinations related to arthritis and COVID-19 were extracted retrospectively from Twitter. Content analysis was used to identify common themes within tweets, and sentiment analysis was used to examine positive and negative emotions in themes to understand the COVID-19 experiences of people with arthritis. Results In total, 149 tweets were analyzed. The majority of tweeters were female and were from the United States. Tweeters reported a range of arthritis conditions, including rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis. Seven themes were identified: health care experiences, personal stories, links to relevant blogs, discussion of arthritis-related symptoms, advice sharing, messages of positivity, and stay-at-home messaging. Sentiment analysis demonstrated marked anxiety around medication shortages, increased physical symptom burden, and strong desire for trustworthy information and emotional connection. Conclusions Tweets by people with arthritis highlight the multitude of concurrent concerns during the COVID-19 pandemic. Understanding these concerns, which include heightened physical and psychological symptoms in the context of treatment misinformation, may assist clinicians to provide person-centered care during this time of great health uncertainty.

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“…Re-opening of communities and countries based on the release of ineffective or partially effective vaccines could have dire impacts as also indicated by the FDA’s requirements for rigorous trials before vaccine approval [ 377 ]. A premature statement could have unintended consequences, such as the unproven promise of hydroxychloroquine in COVID-19 treatment that led to a shortage for Lupus patients [ 378 ]. The efficacy and durability of immunity by COVID-19 vaccines are unknown and may require a two-dose heterogeneous prime-boost strategy or a periodic booster dose [ 379 , 380 ].…”

Section: Perspectivesmentioning

confidence: 99%

COVID-19 vaccines: The status and perspectives in delivery points of view

Chung

Thone

Kwon

2021

Advanced Drug Delivery Reviews

279

250

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Due to the high prevalence and long incubation periods often without symptoms, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected millions of individuals globally, causing the coronavirus disease 2019 (COVID-19) pandemic. Even with the recent approval of the anti-viral drug, remdesivir, and Emergency Use Authorization of monoclonal antibodies against S protein, bamlanivimab and casirimab/imdevimab, efficient and safe COVID-19 vaccines are still desperately demanded not only to prevent its spread but also to restore social and economic activities via generating mass immunization. Recent Emergency Use Authorization of Pfizer and BioNTech’s mRNA vaccine may provide a pathway forward, but monitoring of long-term immunity is still required, and diverse candidates are still under development. As the knowledge of SARS-CoV-2 pathogenesis and interactions with the immune system continues to evolve, a variety of drug candidates are under investigation and in clinical trials. Potential vaccines and therapeutics against COVID-19 include repurposed drugs, monoclonal antibodies, antiviral and antigenic proteins, peptides, and genetically engineered viruses. This paper reviews virology and immunology of SARS-CoV-2, alternative therapies for COVID-19 to vaccination, principles and design considerations in COVID-19 vaccine development, and the promises and roles of vaccine carriers in addressing the unique immunopathological challenges presented by the disease.

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Potential Shortages of Hydroxychloroquine for Patients with Lupus During the Coronavirus Disease 2019 Pandemic

Cited by 43 publications

References 6 publications

COVID-19 in systemic lupus erythematosus: Data from a survey on 417 patients

COVID-19 in systemic lupus erythematosus: Data from a survey on 417 patients

Tweets by People With Arthritis During the COVID-19 Pandemic: Content and Sentiment Analysis

COVID-19 vaccines: The status and perspectives in delivery points of view

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