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0 0.5 1 1.5 2+ Case 4% Improvement Relative Risk Gendebien et al. HCQ for COVID-19 PrEP Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 225 patients in Belgium Study underpowered to detect differences Gendebien et al., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-218244 Favors HCQ Favors control
Systematic analysis of COVID-19 infection and symptoms in a systemic lupus erythematosus population: correlation with disease characteristics, hydroxychloroquine use and immunosuppressive treatments
Gendebien et al., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-218244 (Letter)
Gendebien et al., Systematic analysis of COVID-19 infection and symptoms in a systemic lupus erythematosus population:.., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-218244 (Letter)
Jun 2020   Source   PDF  
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Small study of SLE patients taking HCQ with a phone survey for COVID-19 suggestive symptoms. There was 2 hospitalizations (group not identified) and no ICU or death cases. A similar percentage of suspected infections were reported for HCQ users and non-HCQ users, RR 0.96, p = 0.93.
There was no mortality and severity was not analyzed to determine if HCQ treated patients fared better. No adjustment for concomitant medications or severity of SLE. Only 5 cases were PCR confirmed. This study is excluded in the after exclusion results of meta analysis: not fully adjusting for the baseline risk differences within systemic autoimmune patients.
risk of case, 3.9% lower, RR 0.96, p = 0.93, treatment 12 of 152 (7.9%), control 6 of 73 (8.2%), NNT 308.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Gendebien et al., 25 Jun 2020, retrospective, Belgium, preprint, survey, 9 authors.
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Abstract: Correspondence We read with interest the article of Bozzalla Cassione et al about COVID-19 incidence in their systemic lupus erythematosus (SLE) cohort.1 Their study adds useful epidemiological information about COVID-19 risk in SLE.1 They suggest that hydroxycholoroquine was not protective, but could not draw definite conclusion and open the question to immunosuppressive drugs’ influence. We would like to share analysis of our SLE cohort (n=225) that can help to answer these questions and determine COVID-19 infection risk factors. Determining COVID-19 incidence is challenging: PCR lacks sensitivity, was usually realised only in severely ill patients and patients with suggestive benign symptoms could stay at home without medical contact. We studied the incidence of COVID-19 infection, either asserted or suspected, by analysing positive nasopharyngeal PCR, hospitalisation or contact with emergency department, but also suspected diagnosis in ambulatory medicine. Each patient was called by phone to determine COVID-19 suggestive symptoms since 4 February 2020, date of the first case in our country. Among our patients, 92.9% were female, with a mean (±SD) age of 51.7 (±14.9) years. Most recent biological evaluation showed positivity for ds-­DNA in 24% (median (min–max) levels: 139 (12–758) IU/mL). Mean (±SD) number of 1997 American College of Rheumatology (ACR), 2019 American College of Rheumatology/European League Against Rheumatism (ACR/ EULAR) and Systemic Lupus International Collaborating Clinics (SLICC) classification criteria were 4.5 (±1.5), 20.0 (±8.1) and 5.8 (±2.2), respectively. One hundred and fifty-­two (68.1%) patients received chronic treatment with hydroxychloroquine, Table 1 while 92 (42.4%) had an immunosuppressive treatment (glucocorticoid: 25.3%; other immunosuppressive drug: 31.4%). Mean (±SD) glucocorticoid dose was 4.2 (±2.9) mg of methylprednisolone. Immunosuppressive drugs were ledertrexate (n=23, 10.2%), mycophenolate/tacrolimus/everolimus (n=21, 9.3%), azathioprine (n=25, 11.1%), belimumab (n=5, 2.2%) and rituximab (n=3, 1.3%). In our cohort, a high suspicion of COVID-19 infection was not uncommon, but with absence of severity. Infection was confirmed or suspected by medical team in 18 (8.0%) patients (table 1): 5 (2.2%) had a positive PCR; 7 (3.1%) were admitted to emergency department (without hospitalisation) and 2 (0.9%) were hospitalised (without intensive care unit, while 1 for the Italian cohort1) with COVID-19 infection suspected or confirmed by the medical team; and 14 (6.2%) were highly suspected of COVID-19 after a medical appointment in ambulatory medicine. COVID-19 suggestive symptoms were listed in table 1: in particular, anosmia/ageusia were declared in 7.6%. The Italian cohort identified a similar rate of positive PCR (2.5%), but a lower rate of COVID-19 suspicion (4.8%): however, they considered a strict definition with association of symptoms and contact with a positive case, while we also declare high clinical suspicion in ambulatory medicine.1 Another series from New York (NY) estimated the incidence of COVID-19 infection at 2%, but without systematic patient contact2 and could miss paucisymptomatic patients. Our data supported the ineffectiveness of chronic use of hydroxychloroquine to prevent COVID-19 disease and symptoms in SLE population, with similar rate of COVID-19 infection or suspicion (infection or suspicion in 12 out of 152 (7.9%) patients treated with hydroxychloroquine, while in..
Please send us corrections, updates, or comments. Vaccines and 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. FLCCC and WCH provide treatment protocols.
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