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30-09-2020 | Rheumatology | News | Article

Hydroxychloroquine use may not lower COVID-19 risk in people with RMDs

Claire Barnard

medwireNews: Long-term hydroxychloroquine treatment is not associated with a reduced risk for developing COVID-19 among patients with rheumatic and musculoskeletal diseases (RMDs), research suggests.

“The findings of this study expand the knowledge base on the role of hydroxychloroquine in SARS-CoV-2 infection, supporting preliminary data from smaller studies suggesting that hydroxychloroquine might not be an effective agent to prevent SARS-CoV-2 infection,” write the study authors in The Lancet Rheumatology.

Chris Gentry (Oklahoma City Veterans Affairs Healthcare System, USA) and colleagues used an administrative database to analyze data from 10,703 US veterans with RMDs who were alive on 1 March 2020 and had received at least four 90-day supplies of hydroxychloroquine in the previous year. These people were propensity score-matched to 21,406 patients who were not receiving hydroxychloroquine.

Rheumatoid arthritis was the most commonly represented RMD in both groups (67.2–70.3%), followed by systemic lupus erythematosus (20.9–24.7%). In all, 30.4–31.7% of patients were taking conventional DMARDs other than hydroxychloroquine, while 14.5–15.1% were on biologics, and 7.1–7.9% were taking a conventional DMARD plus a biologic. The average age of the patients was approximately 65 years, and around three-quarters were men.

Gentry and team found that the incidence of confirmed SARS-CoV-2 infection was comparable in the hydroxychloroquine and control groups, at 0.3% and 0.4%, respectively. Moreover, among individuals who tested positive for SARS-CoV-2, rates of COVID-19-related hospital admission were similar in the two groups (29.0 vs 24.4%), as were rates of intensive care unit admission among hospitalized patients (22.2 vs 21.1%).

Overall rates of mortality were significantly lower among patients taking hydroxychloroquine compared with those in the control group (0.8 vs 1.2%), which the researchers suggest could be due to “high adherence to hydroxychloroquine [resulting] in prolonged survival in patients with systemic lupus erythematosus and rheumatoid arthritis,” or the “slightly younger” average age in the hydroxychloroquine group (64.8 vs 65.4 years).

However, “[g]iven that our study’s primary purpose was to investigate the association between a drug and prevention of a specific infection, we cannot make conclusions about the observed difference in overall mortality,” they caution.

The researchers also carried out a multivariate analysis and identified a number of other variables that were independently associated with SARS-CoV-2 infection risk, including the presence of polyarthritis (odds ratio [OR]=4.01), non-White race (OR=1.65), urban residence (OR=1.78), and C-reactive protein levels of more than 10 µg/mL (OR=2.14). Hydroxychloroquine use was not significantly associated with SARS-CoV-2 infection risk in the multivariate analysis.

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

30 September 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.

Lancet Rheumatol 2020; doi:10.1016/S2665-9913(20)30305-2

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