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0 0.5 1 1.5 2+ Hospitalization 24% Improvement Relative Risk Hospitalization (b) 55% HCQ for COVID-19  Cordtz et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 29,440 patients in Denmark Study underpowered to detect differences Cordtz et al., Rheumatology, December 2020 Favors HCQ Favors control

Incidence and severeness of COVID-19 hospitalisation in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark

Cordtz et al., Rheumatology, doi:10.1093/rheumatology/keaa897
Dec 2020  
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Retrospective 58,052 rheumatic disease patients in Denmark showing that RA patients have a higher risk of COVID-19 hospitalization in general. HCQ treated patients show lower risk, although this is not statistically significant with only 3 hospitalizations for HCQ treated patients.
HR 0.76 [0.23-2.52] time-dependent exposure model
HR 0.45 [0.11-1.92] time-fixed exposure model
Although the 24% lower hospitalization is not statistically significant, it is consistent with the significant 16% lower hospitalization [6‑24%] from meta analysis of the 62 hospitalization results to date.
risk of hospitalization, 24.0% lower, HR 0.76, p = 0.67, treatment 3 of 2,722 (0.1%), control 38 of 26,718 (0.1%), NNT 3124, adjusted per study, time-dependent exposure model.
risk of hospitalization, 55.0% lower, HR 0.45, p = 0.28, treatment 3 of 2,722 (0.1%), control 38 of 26,718 (0.1%), adjusted per study, time-fixed exposure model.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Cordtz et al., 28 Dec 2020, retrospective, population-based cohort, Denmark, peer-reviewed, 10 authors.
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Incidence and severeness of COVID-19 hospitalization in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark
René Cordtz, Jesper Lindhardsen, Bolette G Soussi, Jonathan Vela, Line Uhrenholt, Rasmus Westermann, Salome Kristensen, Henrik Nielsen, Christian Torp-Pedersen, Lene Dreyer
Rheumatology, doi:10.1093/rheumatology/keaa897
Objectives. To estimate the incidence of COVID-19 hospitalization in patients with inflammatory rheumatic disease (IRD); in patients with RA treated with specific DMARDs; and the incidence of severe COVID-19 infection among hospitalized patients with RA. Methods. A nationwide cohort study from Denmark between 1 March and 12 August 2020. The adjusted incidence of COVID-19 hospitalization was estimated for patients with RA; spondyloarthritis including psoriatic arthritis; connective tissue disease; vasculitides; and non-IRD individuals. Further, the incidence of COVID-19 hospitalization was estimated for patients with RA treated and non-treated with TNF-inhibitors, HCQ or glucocorticoids, respectively. Lastly, the incidence of severe COVID-19 infection (intensive care, acute respiratory distress syndrome or death) among hospital-admitted patients was estimated for RA and non-IRD sp -individudals. Results. Patients with IRD (n ¼ 58 052) had an increased partially adjusted incidence of hospitalization with COVID-19 compared with the 4.5 million people in the general population [hazard ratio (HR) 1.46, 95% CI: 1.15, 1.86] with strongest associations for patients with RA (n ¼ 29 440, HR 1.72, 95% CI: 1.29, 2.30) and vasculitides (n ¼ 4072, HR 1.82, 95% CI: 0.91, 3.64). There was no increased incidence of COVID-19 hospitalization associated with TNF-inhibitor, HCQ nor glucocorticoid use. COVID-19 admitted patients with RA had a HR of 1.43 (95% CI: 0.80, 2.53) for a severe outcome. Conclusion. Patients with IRD were more likely to be admitted with COVID-19 than the general population, and COVID-19 admitted patients with RA could be at higher risk of a severe outcome. Treatment with specific DMARDs did not affect the risk of hospitalization.
Supplementary data Supplementary data are available at Rheumatology online.
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