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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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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 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 419 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 109 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
Ahj, Sparks, Liew, A rush to judgment? rapid reporting and dissemination of results and its consequences regarding the use of hydroxychloroquine for COVID-19, Ann Intern Med
Arnold, Buckner, Hydroxychloroquine for treatment of SARS-CoV-2 infection? improving our confidence in a model-based approach to dose selection, Clin Transl Sci, doi:10.1111/cts.12797
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
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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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