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0 0.5 1 1.5 2+ Mortality -8% Improvement Relative Risk Hospitalization 18% Mortality (b) -19% Hospitalization (b) 12% HCQ for COVID-19  Alegiani et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective study in Italy Lower hospitalization with HCQ (p=0.026) Alegiani et al., Rheumatology, April 2021 Favors HCQ Favors control

Risk of COVID-19 hospitalization and mortality in rheumatic patients treated with hydroxychloroquine or other conventional DMARDs in Italy

Alegiani et al., Rheumatology, doi:10.1093/rheumatology/keab348
Apr 2021  
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Retrospective database analysis case control study of rheumatic patients. When compared with other cDMARDs, HCQ users had significantly lower hospitalization, however there was no significant difference in mortality. Results differ significantly from previous studies, for example showing mortality OR 0.94 [0.83-1.06] for patients with rheumatic disease and mortality OR 0.88 [0.74-1.05] for patients with RA/SLE. Other research shows that the risk of COVID-19 for systemic autoimmune disease patients is much higher overall.
risk of death, 8.0% higher, OR 1.08, p = 0.64, HCQ vs. other cDMARDs, RR approximated with OR.
risk of hospitalization, 18.0% lower, OR 0.82, p = 0.03, HCQ vs. other cDMARDs, RR approximated with OR.
risk of death, 19.0% higher, OR 1.19, p = 0.32, HCQ vs. MTX, RR approximated with OR.
risk of hospitalization, 12.0% lower, OR 0.88, p = 0.17, HCQ vs. MTX, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Alegiani et al., 15 Apr 2021, retrospective, case control, database analysis, Italy, peer-reviewed, 16 authors.
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Risk of coronavirus disease 2019 hospitalization and mortality in rheumatic patients treated with hydroxychloroquine or other conventional disease-modifying anti-rheumatic drugs in Italy
Stefania Spila Alegiani, Salvatore Crisafulli, Paolo Giorgi Rossi, Pamela Mancuso, Carlo Salvarani, Fabiola Atzeni, Rosa Gini, Ursula Kirchmayer, Valeria Belleudi, Peter Konstantin Kurotschka, Olivia Leoni, Monica Ludergnani, Eliana Ferroni, Susanna Baracco, Marco Massari, Gianluca Trifirò
Rheumatology, doi:10.1093/rheumatology/keab348
Objectives. To ascertain if the use of hydroxychloroquine(HCQ)/cloroquine(CLQ) and other conventional DMARDs (cDMARDs) and rheumatic diseases per se may be associated with COVID-19-related risk of hospitalization and mortality. Methods. This case-control study nested within a cohort of cDMARD users was conducted in the Lombardy, Veneto, Tuscany and Lazio regions and Reggio Emilia province. Claims databases were linked to COVID-19 surveillance registries. The risk of COVID-19-related outcomes was estimated using a multivariate conditional logistic regression analysis comparing HCQ/CLQ vs MTX, vs other cDMARDs and vs non-use of these drugs. The presence of rheumatic diseases vs their absence in a non-nested population was investigated. Results. A total of 1275 patients hospitalized due to COVID-19 were matched to 12 734 controls. Compared with recent use of MTX, no association between HCQ/CLQ monotherapy and COVID-19 hospitalization [odds ratio (OR) 0.83 (95% CI 0.69, 1.00)] or mortality [OR 1.19 (95% CI 0.85, 1.67)] was observed. A lower risk was found when comparing HCQ/CLQ use with the concomitant use of other cDMARDs and glucocorticoids. HCQ/CLQ was not associated with COVID-19 hospitalization as compared with non-use. An increased risk for recent use of either MTX monotherapy [OR 1.19 (95% CI 1.05, 1.34)] or other cDMARDs [OR 1.21 (95% CI 1.08, 1.36)] vs non-use was found. Rheumatic diseases were not associated with COVID-19-related outcomes. Conclusion. HCQ/CLQ use in rheumatic patients was not associated with a protective effect against COVID-19related outcomes. The use of other cDMARDs was associated with an increased risk when compared with non-use and, if concomitantly used with glucocorticoids, also vs HCQ/CLQ, probably due to immunosuppressive action.
Supplementary data Supplementary data are available at Rheumatology online.
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