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0 0.5 1 1.5 2+ Case -50% Improvement Relative Risk c19hcq.org Cassione et al. HCQ for COVID-19 PrEP Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 165 patients in Italy More cases with HCQ (not stat. sig., p=0.59) Cassione et al., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-217717 Favors HCQ Favors control
COVID-19 infection in a northern-Italian cohort of systemic lupus erythematosus assessed by telemedicine
Cassione et al., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-217717 (Letter)
Cassione et al., COVID-19 infection in a northern-Italian cohort of systemic lupus erythematosus assessed by telemedicine, Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-217717 (Letter)
May 2020   Source   PDF  
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Survey of 165 SLE patients, 127 on HCQ. 8 patients with suspected COVID-19 and 4 confirmed cases. No mortality, one ICU case. 7 patients had no symptoms despite contact with a COVID-19 patient.
No adjustment for concomitant medications or severity of SLE. Confounding by indication. This study is excluded in the after exclusion results of meta analysis: not fully adjusting for the different baseline risk of systemic autoimmune patients.
risk of case, 49.6% higher, RR 1.50, p = 0.59, treatment 10 of 127 (7.9%), control 2 of 38 (5.3%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Cassione et al., 12 May 2020, retrospective, Italy, preprint, survey, median age 52.5, 6 authors.
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Abstract: Letters Confirmed COVID-19 Clinical-­ COVID-19 Patients, n (% of total cohort) 4 (2.5) 8 (5) Female, n (% of the group) 4 (100) 7 (87.5) Median age in years (range) 52.5 (27–53) 34 (25–59) Median disease duration in years (range) 21.5 (14–29.75) 11 (5–20) Comorbidities, n (%)  Hypertension 2 (50)  Diabetes 0 (0) 2 (25) 0 (0)  Cardiovascular disease 1 (25) 0 (0)  Obesity 0 (0) 0 (0)  Active 1 (25) 0 (0)  Previous 0 (0) 2 (25) Hydroxychloroquine 3 (75) 7 (87.5) Glucocorticoids (≤7.5 mg/day) 1 (25) 3 (37.5) Mycophenolate 3 (75) 3 (37.5) Azathioprine 0 (0) 1 (12.5) Cyclosporine 0 (0) 1 (12.5) Smoking, n (%) Therapy, n (%) Symptoms, n (%) ​ ​ ​ ​ ​ ​ ​ ​ COVID-19 infection in a northern-­Italian cohort of systemic lupus erythematosus assessed by telemedicine The COVID-19 pandemic deeply affected northern-­ Italian Romagna had the highest regions.1 Lombardy and Emilia-­ cumulative incidence with 627.1 and 470.53 cases/100 000 inhabitants respectively on 16 April 2020 according to Italian ‘Istituto Superiore di Sanità’ (ISS). While a mild course has been reported in patients with chronic arthritis treated with targeted immunosuppressive agents,2 few and controversial data are available about COVID-19 in systemic lupus erythematosus (SLE).3 4 To this purpose, since 6 April 2020, given the mobility restriction imposed nationwide, we initiated a telemedicine project aimed at ensuring regular follow-­up, starting from SLE patients.5 During the visit, we conducted a survey to investigate any COVID-19 related symptoms that occurred since 15 February 2020 and the results of available nasopharyngeal swabs. The survey was addressed to patients coming from Lombardy and Emilia-Romagna. We evaluated 165 patients (112 females, 84%, median age 52.5 years, range 25–81; median disease duration 13 years, range 1–53). Among 1382  Fever 3 (75) 8 (100)  Non-­productive cough 2 (50) 8 (100)  Sputum production 1 (25) 4 (50)  Rhinorrhea 3 (75) 4 (50)  Sore throat 2 (50) 4 (50)  Fatigue 2 (50) 6 (75)  Arthromyalgia 2 (50) 5 (62.5)  Anosmia/dysgeusia 2 (50) 4 (50)  Dyspnoea 1 (25) 6 (75)  Headache 2 (50) 6 (75)  Diarrhoea 2 (50) 3 (37.5)  Nausea/vomiting 1 (25) 2 (25) Chest X-­ray performed, n (%) 2 (50) 2 (25) Chest X-­ray pathological findings, n (%) 1 (25) 0 (0) ICU admission, n (%) 1 (25) 0 (0) them, 127 (77%) were on hydroxychloroquine (HCQ), 93 (56%) on prednisone (in 88≤7.5 mg/day), 41 (25%) on mycophenolate mofetil (MMF) and 12 (7%) on other immunosuppressants (methotrexate, cyclosporine or azathioprine). In all cases, treatment was ongoing for more than 6 months. Among them, 12 patients (7.2%) developed COVID-19: four patients (2.5% of the total population) had swab-­confirmed COVID-19 and eight (4.8%) had clinical-­COVID-19 (at least three out of four symptoms among fever, dyspnoea, cough and dysgeusia/ anosmia plus established contact with a COVID-19 patient, no swab performed). Cohort characteristics and therapies are reported in table 1. Among the four confirmed patients only one, a 27-­year-­old woman, needed intensive care for the development of acute respiratory distress syndrome. She has severe SLE (end-­stage renal disease on haemodialysis) and was on MMF (2 g/day), HCQ (200 mg/day) and oral prednisone (7.5 mg/day) before COVID-19. MMF was withdrawn at COVID-19 diagnosis, and after deterioration, methylprednisolone (1 mg/kg/day..
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