Chronic treatment with hydroxychloroquine and SARS-CoV-2 infection
Ferreira et al.,
Chronic treatment with hydroxychloroquine and SARS-CoV-2 infection,
J. Medical Virology, July 9, 2020, doi:10.1002/jmv.26286 (date from earlier preprint)
Chronic treatment with HCQ provides protection against COVID, odds ratio 0.51 (0.37-0.70).
The actual benefit is likely to be larger becasue research shows that the risk of COVID-19 for systemic autoimmune disease patients is much higher overall. Ferri et al. show OR 4.42,
p<0.001
[Ferri], which is the observed real-world risk, taking into account factors such as these patients potentially being more careful to avoid exposure.
risk of case, 47.1% lower, RR 0.53, p < 0.001, adjusted per study, odds ratio converted to relative risk.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Ferreira et al., 29 Jun 2020, retrospective, population-based cohort, database analysis, Portugal, peer-reviewed, 3 authors.
Abstract: Received: 30 June 2020
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Accepted: 6 July 2020
DOI: 10.1002/jmv.26286
RESEARCH ARTICLE
Chronic treatment with hydroxychloroquine and
SARS‐CoV‐2 infection
António Ferreira MD, PhD1
| António Oliveira‐e‐Silva MD2 | Paulo Bettencourt MD, PhD3
1
Unidade de Investigação Cardiovascular
(UniC), Faculdade de Medicina, Universidade
do Porto, Hospital Rainha Santa Isabel, Centro
Hospitalar Universitário de São João, Porto,
Portugal
2
Hospital de Braga, Braga, Portugal
Abstract
Hydroxychloroquine sulfate (HCQ) is being scrutinized for repositioning in the
treatment and prevention of severe acute respiratory syndrome coronavirus 2
(SARS‐CoV‐2) infection. This antimalarial drug is also chronically used to treat pa-
3
Unidade de Investigação Cardiovascular
(UniC), Faculdade de Medicina, Universidade
do Porto, Hospital CUF, Porto, Portugal
Correspondence
António Ferreira, MD, PhD, Unidade de
Investigação Cardiovascular (UniC), Faculdade
de Medicina, Universidade do Porto, Hospital
Rainha Santa Isabel, Centro Hospitalar
Universitário de São João, 4200‐319 Porto,
Portugal.
Email: aloboferreira@gmail.com
tients with autoimmune diseases. By analyzing the Portuguese anonymized data on
private and public based medical prescriptions we have identified all cases chronically receiving HCQ for the management of diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and other autoimmune diseases. Additionally, we
have detected all laboratory confirmed cases of SARS‐CoV‐2 infection and all laboratory confirmed negative cases in the Portuguese population (mandatorily registered in a
centrally managed database). Cross linking the two sets of data has allowed us to
compare the proportion of HCQ chronic treatment (at least 2 grams per month) in
laboratory confirmed cases of SARS‐CoV‐2 infection with laboratory confirmed negative cases. Out of 26 815 SARS‐CoV‐2 positive patients, 77 (0.29%) were chronically
treated with HCQ, while 1215 (0.36%) out of 333 489 negative patients were receiving
it chronically (P = .04). After adjustment for age, sex, and chronic treatment with corticosteroids and/or immunosuppressants, the odds ratio of SARS‐CoV‐2 infection for
chronic treatment with HCQ has been 0.51 (0.37‐0.70). Our data suggest that chronic
treatment with HCQ confer protection against SARS‐CoV‐2 infection.
KEYWORDS
chemotherapy, disease control, economic reason, public policy, SARS coronavirus, social
science, virus classification
1 | INTRODUCTION
designed, randomized, double blinded, placebo controlled clinical
trials showing any evidence of a therapeutic or preventive effect
Several in vitro studies have shown chloroquine phosphate and
hydroxychloroquine sulfate (HCQ) to be effective in both pre-
of these drugs in SARS‐CoV‐2 infection.
These two drugs are also chronically used to treat systemic lupus
syndrome
erythematosus (SLE), rheumatoid arthritis (RA), and other auto-
coronavirus 2 (SARS‐CoV‐2) infection in isolated cells.1‐3 Chlor-
immune diseases. SLE patients are at increased risk of viral infec-
oquine phosphate and HCQ were also found effective in the
tions.8 Increased ratios of serious bacterial and viral infections have
treatment of patients with COVID‐19 in small nonrandomized or
been shown or are expected in different autoimmune diseases.8‐11
venting
and
treating
severe
4‐6
acute
respiratory
A recent observational study has
Thus, patients with these diseases should be expected to have in-
shown no..
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treatments are complementary. All practical, effective, and safe means should
be used based on risk/benefit analysis. No treatment, vaccine, or intervention
is 100% available and effective for all current and future variants. We do not
provide medical advice. Before taking any medication, consult a qualified
physician who can provide personalized advice and details of risks and
benefits based on your medical history and situation.
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provide treatment protocols.
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