Prevalence of COVID-19 in patients with rheumatoid arthritis (RA) already treated with hydroxychloroquine (HCQ) compared with HCQ-naive patients with RA: a multicentre cross-sectional study

Abstract: Prevalence of COVID-19 in patients with rheumatoid arthritis (RA) already treated with hydroxychloroquine (HCQ) compared with HCQ-­naive patients with RA: a multicentre cross-­ sectional study COVID-19 is becoming the most serious problem of human society after World War II. The general recommendations of WHO, which include wearing mask, social distancing, washing hands and so on, are a widely accepted approach to preventing the spread of the virus. With lack of effective treatment, prophylactic strategies have attracted the attention of healthcare providers. Chemoprophylaxis is one of these strategies. Several in vitro studies showed that antimalarial agents interfere with the proliferation of various viruses, including the severe acute respiratory syndrome coronavirus, by inhibiting virus/ cell fusion.1 However, the main challenge is translating the impact of in vitro models to clinics. Given the higher mortality of patients with COVID-19 with autoimmune diseases,2 we decided to investigate the efficacy of these medications by evaluating the incidence of COVID-19 in patients with rheumatoid arthritis (RA) already treated with hydroxychloroquine (HCQ) compared with HCQ-­naive patients with RA. In a multicentre cross-­ sectional study, patients with RA treated in the rheumatology clinics of the Tabriz University of Medical Sciences, Kashan University of Medical Sciences and Army Hospital of Tehran were recruited. For a period of 4 weeks from 19 August to 19 September 2020, data about symptoms suggestive of COVID-19 were obtained by telephone interview. Inclusion criteria were fulfilment of the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for RA, disease onset at age ≥16 and disease onset before the COVID-19 outbreak. Exclusion criteria were change or addition of new disease-­modifying antirheumatic drugs during the last 8 months, non-­adherence to medication, refusal to answer the questions and non-­response to Table 1 Demographic and clinical characteristics and medications of patients with RA enrolled in the study Characteristics and medications HCQ (n=1436) HCQ-­naive (n=422) P value Female (%) 1035 (72.1) 301 (71.3) 0.404 Age, mean±SD 51.1±12.3 50.6±13.1 0.123 RA disease duration, median (IQR) 54 (30–109) 66 (38–120) 0.193  Obesity (BMI >30) 253 (17.6) 63 (14.9) 0.252  Smoking 112 (7.8) 27 (6.4) 0.339  Diabetes 153 (10.7) 51 (12.1) 0.116  Hypertension 183 (12.7) 46 (10.9) 0.186  Pulmonary disease 33 (2.3) 13 (3.1) 0.127  Heart disease 36 (2.5) 10 (2.4) 0.592  Chronic kidney disease 13 (0.9) 5 (1.2) 0.271  Malignancies 19 (1.3) 3 (0.7) 0.419 Active RA disease 235 (16.4) 73 (17.3) 0.382  NSAIDs 159 (11.1) 51 (12.1) 0.326  Prednisolone 1057 (73.6) 326 (77.3) 0.059  Prednisolone dose, median (IQR) 5 (2.5–7.5) 5 (2.5–7.5) 0.106  Methotrexate 1106 (77.0) 318 (75.3) 0.328  Sulfasalazine 136 (9.5) 81 (19.2) 0.001  Leflunomide 219 (15.3) 55 (13.0) 0.222  Azathioprine 12 (0.9) 7 (1.7) 0.166  Calcineurin inhibitors 72 (0.5) 6 (1.4) 0.122  Biologics 40 (2.8) 15 (3.6) 0.314 COVID-19 (%) 34 (2.2) 12 (2.8) 0.344 Risk factors for COVID-19 (%) Medications (%) *p<0.05 considered significant. BMI, body mass index; HCQ, hydroxychloroquine; NSAIDs, non-­steroidal anti-­inflammatory drugs; RA, rheumatoid arthritis. Postgrad Med J Month 2021 Vol 0 No 0 three phone calls. Patients with..