Long-term hydroxychloroquine use in patients with rheumatic conditions and development of SARS-CoV-2 infection: a retrospective cohort study
Gentry et al.
, Long-term hydroxychloroquine use in patients with rheumatic conditions and development of SARS-CoV-2..
, Lancet Rheumatology, doi:10.1016/S2665-9913(20)30305-2
Retrospective patients with rheumatologic conditions showing zero of 10,703 COVID-19 deaths for HCQ patients versus 7 of 21,406 propensity matched control patients (not statistically significant). The average age of HCQ patients is slightly lower 64.8 versus 65.4 control.
COVID-19 cases OR 0.79, p
=0.27. There are several significant differences in the propensity matched patients that could affect results, e.g., 20.9% SLE versus 24.7%.
risk of death, 91.3% lower, RR 0.09, p = 0.10, treatment 0 of 10,703 (0.0%), control 7 of 21,406 (0.0%), NNT 3058, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm), COVID-19 mortality within all patients.
risk of death, 90.7% lower, RR 0.09, p = 0.19, treatment 0 of 31 (0.0%), control 7 of 78 (9.0%), NNT 11, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm), mortality for infected patients.
risk of case, 20.9% lower, RR 0.79, p = 0.27, treatment 31 of 10,703 (0.3%), control 78 of 21,406 (0.4%), NNT 1338, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Gentry et al., 21 Sep 2020, retrospective, database analysis, USA, peer-reviewed, 6 authors.
Long-term hydroxychloroquine use in patients with
rheumatic conditions and development of SARS-CoV-2
infection: a retrospective cohort study
Chris A Gentry, Mary Beth Humphrey, Sharanjeet K Thind, Sage C Hendrickson, George Kurdgelashvili, Riley J Williams II
Background Hydroxychloroquine is one of several agents being evaluated in the treatment of severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to examine whether patients with rheumatological
conditions receiving chronic hydroxychloroquine therapy are at less risk of developing SARS-CoV-2 infection than
those not receiving hydroxychloroquine.
Methods This retrospective cohort study included de-identified information of all veterans in the US Veterans Health
Administration clinical administrative database aged 18 years or older with rheumatoid arthritis, systemic lupus
erythematosus, or associated rheumatological conditions (based on International Classification of Diseases, 10th edition,
diagnostic codes) who were alive on March 1, 2020. A propensity score was calculated for each patient, and each patient
who was receiving hydroxychloroquine was matched to two patients who were not receiving hydroxychloroquine
(controls). The primary endpoint was the proportion of patients with PCR-confirmed SARS-CoV-2 infection among
those receiving chronic hydroxychloroquine versus the propensity-matched patients not receiving chronic
hydroxychloroquine between March 1 and June 30, 2020. Secondary outcomes were hospital admission associated
with SARS-CoV-2 infection; intensive care requirement associated with SARS-CoV-2 infection; mortality associated with
SARS-CoV-2 infection; and overall rates of any hospital admission and mortality (ie, all cause). Multivariate logistic
regression analysis was done to determine independent variables for the development of active SARS-CoV-2 infection.
Findings Between March 1 and June 30, 2020, 10 703 patients receiving hydroxychloroquine and 21 406 patients not
receiving hydroxychloroquine were included in the primary analysis. The incidence of active SARS-CoV-2 infections
during the study period did not differ between patients receiving hydroxychloroquine and patients not receiving
hydroxychloroquine (31 [0·3%] of 10 703 vs 78 [0·4%] of 21 406; odds ratio 0·79, 95% CI 0·52–1·20, p=0·27). There
were no significant differences in secondary outcomes between the two groups in patients who developed active
SARS-CoV-2 infection. For all patients in the study, overall mortality was lower in the hydroxychloroquine group than
in the group of patients who did not receive hydroxychloroquine (odds ratio 0·70, 95% CI 0·55–0·89, p=0·0031). In
multivariate logistic regression analysis, receipt of hydroxychloroquine was not associated with the development of
active SARS-CoV-2 infection (odds ratio 0·79, 95% CI 0·51–1·42).
Interpretation Hydroxychloroquine was not associated with a preventive effect against SARS-CoV-2 infection in a large
group of patients with rheumatological conditions.
Lancet Rheumatol 2020;
September 21, 2020
See Comment page e650
(C A Gentry PharmD,
S C Hendrickson PharmD,
R J Williams II PharmD)
and Section of
(Prof M B Humphrey MD) and
Section of Infectious Diseases
(S K Thind MD,
G Kurdgelashvili MD), Medical
Service, Oklahoma City
Veterans Affairs Healthcare
System, Oklahoma City,..
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