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All Studies   Meta Analysis    Recent:   

COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series

Ferri et al., Clinical Rheumatology, doi:10.1007/s10067-020-05334-7
Aug 2020  
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COVID-19 case 63% Improvement Relative Risk HCQ for COVID-19  Ferri et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 1,641 patients in Italy Fewer cases with HCQ (p=0.015) c19hcq.org Ferri et al., Clinical Rheumatology, Aug 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
Analysis of 1641 systemic autoimmune disease patients showing csDMARD (HCQ etc.) RR 0.37, p=0.015.
csDMARDs include HCQ, CQ, and several other drugs, so the effect of HCQ/CQ alone could be higher.
This study also confirms that the risk of COVID-19 for systemic autoimmune disease patients is much higher overall, OR 4.42, p<0.001 (this is the observed real-world risk which takes into account factors such as these patients potentially being more careful to avoid exposure).
(results are for "definite + highly suspected" cases and the main result is presented in the paper as the OR for not taking csDMARDs, we have converted this to RR for taking csDMARDs).
risk of COVID-19 case, 63.0% lower, RR 0.37, p = 0.01, treatment 9 of 994 (0.9%), control 16 of 647 (2.5%), NNT 64.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ferri et al., 27 Aug 2020, retrospective, Italy, peer-reviewed, survey, 29 authors.
This PaperHCQAll
COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series
Clodoveo Ferri, Dilia Giuggioli, Vincenzo Raimondo, Massimo L’andolina, Antonio Tavoni, Riccardo Cecchetti, Serena Guiducci, Francesco Ursini, Maurizio Caminiti, Giuseppe Varcasia, Pietro Gigliotti, Roberta Pellegrini, Domenico Olivo, Michele Colaci, Giuseppe Murdaca, Raffaele Brittelli, Giuseppa Pagano Mariano, Amelia Spinella, Silvia Bellando-Randone, Vincenzo Aiello, Silvia Bilia, Daiana Giannini, Tommaso Ferrari, Rodolfo Caminiti, Veronica Brusi, Riccardo Meliconi, Poupak Fallahi, Alessandro Antonelli
Clinical Rheumatology, doi:10.1007/s10067-020-05334-7
Introduction Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. We investigated the clinical-epidemiological findings of 1641 autoimmune systemic disease Italian patients during the Covid-19 pandemic. Method This observational multicenter study included 1641 unselected patients with autoimmune systemic diseases from three Italian geographical areas with different prevalence of Covid-19 [high in north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of telephone 6-week survey. Covid-19 was classified as (1) definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2) highly suspected Covid-19 disease: presence of highly suggestive symptoms, in absence of a swab test. Results A significantly higher prevalence of patients with definite diagnosis of Covid-19 disease, or with highly suspected Covid-19 disease, or both the conditions together, was observed in the whole autoimmune systemic disease series, compared to "Italian general population" (p = .030, p = .001, p = .000, respectively); and for definite + highly suspected diagnosis of Covid-19 disease, in patients with autoimmune systemic diseases of the three regions (p = .000, for all comparisons with the respective regional general population). Moreover, significantly higher prevalence of definite + highly suspected diagnosis of Covid-19 disease was found either in patients with various "connective tissue diseases" compared to "inflammatory arthritis group" (p < .000), or in
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We investigated the clinical-epidemiological findings of 1641 ' 'autoimmune systemic disease Italian patients during the Covid-19 ' 'pandemic.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>This ' 'observational multicenter study included 1641 unselected patients with autoimmune systemic ' 'diseases from three Italian geographical areas with different prevalence of Covid-19 [high in ' 'north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of ' 'telephone 6-week survey. Covid-19 was classified as ' '(1)<jats:italic>definite</jats:italic>diagnosis of Covid-19 disease: presence of symptomatic ' 'Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2)<jats:italic>highly ' 'suspected</jats:italic>Covid-19 disease: presence of highly suggestive symptoms, in absence ' 'of a swab test.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A ' 'significantly higher prevalence of patients with<jats:italic>definite</jats:italic>diagnosis ' 'of Covid-19 disease<jats:italic>,</jats:italic>or with<jats:italic>highly ' 'suspected</jats:italic>Covid-19 disease, or both the conditions together, was observed in the ' 'whole autoimmune systemic disease series, compared to “Italian general population” ' '(<jats:italic>p</jats:italic>\u2009=\u2009.030,<jats:italic>p</jats:italic>\u2009=\u2009' '.001,<jats:italic>p</jats:italic>\u2009=\u2009.000, respectively); and ' 'for<jats:italic>definite\u2009+\u2009highly suspected</jats:italic>diagnosis of Covid-19 ' 'disease, in patients with autoimmune systemic diseases of the three regions ' '(<jats:italic>p</jats:italic>\u2009=\u2009.000, for all comparisons with the respective ' 'regional general population)<jats:italic>.</jats:italic>Moreover, significantly higher ' 'prevalence of<jats:italic>definite\u2009+\u2009highly suspected</jats:italic>diagnosis of ' 'Covid-19 disease was found either in patients with various “connective tissue diseases” ' 'compared to “inflammatory arthritis group” (<jats:italic>p</jats:italic>\u2009&lt;\u2009' '.000), or in patients without ongoing conventional synthetic disease-modifying anti-rheumatic ' 'drugs treatments (<jats:italic>p</jats:italic>\u2009=\u2009' '.011).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The finding ' 'of a higher prevalence of Covid-19 in patients with autoimmune systemic diseases is ' 'particularly important, suggesting the need to develop valuable prevention/management ' 'strategies, and stimulates in-depth investigations to verify the possible interactions ' 'between Covid-19 infection and impaired immune-system of autoimmune systemic ' 'diseases.<jats:table-wrap><jats:table><jats:tbody><jats:tr><jats:td ' 'colspan="2"><jats:bold>Key Points</jats:bold><jats:italic>• Significantly higher prevalence ' 'of Covid-19 is observed in a large series of patients with autoimmune systemic diseases ' 'compared to the Italian general population, mainly due to patients’ increased susceptibility ' 'to infections and favored by the high exposure to the virus at medical facilities before the ' 'restriction measures on individual movement.</jats:italic><jats:italic>• The actual ' 'prevalence of Covid-19 in autoimmune systemic diseases may be underestimated, possibly due to ' 'the wide clinical overlapping between the two conditions, the generally mild Covid-19 disease ' 'manifestations, and the limited availability of virological ' 'testing.</jats:italic><jats:italic>• Patients with “connective tissue diseases” show a ' 'significantly higher prevalence of Covid-19, possibly due to deeper immune-system impairment, ' 'with respect to “inflammatory arthritis group”.</jats:italic><jats:italic>• Covid-19 is more ' 'frequent in the subgroup of autoimmune systemic diseases patients without ongoing ' 'conventional synthetic disease-modifying anti-rheumatic drugs, mainly hydroxyl-chloroquine ' 'and methotrexate, which might play some protective role against the most harmful ' 'manifestations of ' 'Covid-19.</jats:italic></jats:td></jats:tr></jats:tbody></jats:table></jats:table-wrap></jats:p></jats:sec>', 'DOI': '10.1007/s10067-020-05334-7', 'type': 'journal-article', 'created': {'date-parts': [[2020, 8, 27]], 'date-time': '2020-08-27T10:03:57Z', 'timestamp': 1598522637000}, 'page': '3195-3204', 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 96, 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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment 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. FLCCC and WCH provide treatment protocols.
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