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.
, 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)
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
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
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.
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,
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
provide treatment protocols.