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29-04-2020 | Rheumatology | News | Article

Hydroxychloroquine ‘does not seem to prevent COVID-19’ in people with lupus

Author: Claire Barnard

medwireNews: The authors of a French case series report the clinical experiences of 17 patients with systemic lupus erythematosus (SLE) undergoing long-term treatment with hydroxychloroquine who developed COVID-19.

As reported in a letter published in the Annals of the Rheumatic Diseases, the cohort comprised mainly women (76%); the median SLE disease duration was 8.2 years and the most frequently occurring comorbidity was obesity (59%), followed by chronic kidney disease (47%).

Alexis Mathian (University Hospital Pitié Salpêtrière, Paris) and co-authors say that the median duration of hydroxychloroquine treatment was 7.5 years, and the median blood concentration was 648 ng/mL in the eight patients with available measurements.

In all, 71% of patients were also receiving prednisone treatment, while 41% received concomitant immunosuppressants. Both hydroxychloroquine and prednisone were continued at the same dose after patients were admitted to hospital, but the dose of immunosuppressants was interrupted or reduced.

Over the course of hospitalization, 76% of the cohort developed viral pneumonia, 65% experienced complications due to respiratory failure, and 29% had acute respiratory distress syndrome. A total of 65% of patients required oxygen therapy, including nasal cannula in five individuals, mechanical ventilation in five, and high-flow nasal cannula in one.

Data for the cohort were collected between 29 March and 6 April, and on 7 April half remained in hospital, 36% had been discharged, and 14% had died.

Commenting on these findings in a press release, EULAR Past-President Johannes Bijlsma says: “This gives a first clinical picture of the course of COVID-19 in SLE patients treated with [hydroxychloroquine].”

Mathian et al caution that their case series report “does not allow [one] to draw conclusions on the incidence rate and severity of COVID-19 in SLE.”

However, they say that it “paves the way for a larger observational study to identify the risk factors associated with the occurrence of a severe form of COVID-19 in patients with SLE.”

And the team says that “our preliminary conclusion, based on the observation that most of the patients with SLE in this study received long-term treatment with [hydroxychloroquine], having blood concentrations of the drug within therapeutic range, is that [hydroxychloroquine] does not seem to prevent COVID-19, at least its severe forms, in patients with SLE.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

29 April 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-217566

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