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0 0.5 1 1.5 2+ Hospitalization 3% Improvement Relative Risk HCQ for COVID-19  Konig et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 80 patients in multiple countries No significant difference in hospitalization c19hcq.org Konig et al., Annals of the Rheumatic .., May 2020 Favors HCQ Favors control

Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19

Konig et al., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-217690
May 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now known with p < 0.00000000001 from 421 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments. c19hcq.org
Analysis of 80 SLE patients diagnosed with COVID-19, showing the frequency of hospitalisation did not differ between individuals using an antimalarial versus non-users (55% (16/29) vs 57% (29/51), p=ns. Authors suggest that the dosage used may be too low to reach therapeutic levels.
This study is excluded in the after exclusion results of meta analysis: not fully adjusting for the baseline risk differences within systemic autoimmune patients; unadjusted results with no group details.
risk of hospitalization, 3.0% lower, RR 0.97, p = 0.88, treatment 16 of 29 (55.2%), control 29 of 51 (56.9%), NNT 59.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Konig et al., 7 May 2020, retrospective, database analysis, multiple countries, peer-reviewed, 11 authors.
This PaperHCQAll
Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19
Dr Maximilian F Konig, Alfred Hj Kim, Marc H Scheetz, Elizabeth R Graef, Jean W Liew, Julia Simard, Pedro M Machado, Milena Gianfrancesco, Jinoos Yazdany, Daman Langguth, Dr Philip C Robinson
Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-217690
Disclaimer The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance, and do not necessarily represent the views of the American College of Rheumatology, the European League Against Rheumatism, or any other organisation.
References
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Barnard, Day, Bailey, Evaluation of immunomodulators, interferons and known in vitro SARS-coV inhibitors for inhibition of SARS-coV replication in BALB/c mice, Antivir Chem Chemother, doi:10.1177/095632020601700505
Chen, Hu, Zhang, Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial, Epidemiology
Chorin, Dai, Shulman, The QT interval in patients with SARS-CoV-2 infection treated with Hydroxychloroquine/Azithromycin, Cardiovascular Medicine
Dyall, Coleman, Hart, Repurposing of clinically developed drugs for treatment of middle East respiratory syndrome coronavirus infection, Antimicrob Agents Chemother, doi:10.1128/AAC.03036-14
Dyall, Gross, Kindrachuk, Middle East respiratory syndrome and severe acute respiratory syndrome: current therapeutic options and potential targets for novel therapies, Drugs, doi:10.1007/s40265-017-0830-1
Gianfrancesco, Hyrich, Gossec, Rheumatic disease and COVID-19: initial data from the COVID-19 global rheumatology alliance provider registries, Lancet Rheumatol, doi:10.1016/S2665-9913(20)30095-3
Joob, Wiwanitkit, Sle, hydroxychloroquine and NO SLE patients with COVID-19: a comment, Ann Rheum Dis, doi:10.1136/annrheumdis-2020-217506
Lane, Weaver, Kostka, Safety of hydroxychloroquine, alone and in combination with azithromycin, in light of rapid wide-spread use for COVID-19: a multinational, network cohort and self-controlled case series study, Rheumatology
Liu, Cao, Xu, Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro, Cell Discov, doi:10.1038/s41421-020-0156-0
Mathian, Mahevas, Rohmer, Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under longterm treatment with hydroxychloroquine, Ann Rheumat Dis
Monti, Montecucco, Can hydroxychloroquine protect patients with rheumatic diseases from COVID-19? Response to: 'Does hydroxychloroquine prevent the transmission of COVID-19?' by Heldwein and Calado and 'SLE, hydroxychloroquine and no SLE patients with COVID-19: a comment' by Joob and Wiwanitkit, Ann Rheum Dis
Petri, Elkhalifa, Li, Hydroxychloroquine blood levels predict hydroxychloroquine retinopathy, Arthritis Rheumatol, doi:10.1002/art.41121
Rayner, Bulik, Kamal, Pharmacokinetic-Pharmacodynamic determinants of oseltamivir efficacy using data from phase 2 inoculation studies, Antimicrob Agents Chemother, doi:10.1128/AAC.02440-12
Roden, Harrington, Poppas, Considerations for drug interactions on QTc in exploratory COVID-19 (coronavirus disease 2019) treatment, J Am Coll Cardiol, doi:10.1016/j.jacc.2020.04.016
Tang, Cao, Han, Hydroxychloroquine in patients with COVID-19: an openlabel, randomized, controlled trial, Infectious Diseases, doi:10.1101/2020.04.10.20060558
Trump, Vice, Pence, Members of the Coronavirus Task Force in Press Briefing
Tuntland, Ethell, Kosaka, Implementation of pharmacokinetic and pharmacodynamic strategies in early research phases of drug discovery and development at Novartis Institute of biomedical research, Front Pharmacol, doi:10.3389/fphar.2014.00174
Yao, Ye, Zhang, In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Clin Infect Dis, doi:10.1093/cid/ciaa237
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