COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and Meta-Analysis
Isabela Landsteiner De Sampaio Amêndola, Jonathan Aires Pinheiro, Pedro Póvoa, Vicente Cés De Souza Dantas, Rodrigo Bernardo Serafim
Journal of Clinical Medicine, doi:10.3390/jcm11226865
The ongoing chronic use of hydroxychloroquine or chloroquine (HCQ/CQ) in rheumatic patients might impact their outcomes after a SARS-CoV-2 infection. Therefore, we sought to assess the mortality in rheumatic patients with chronic HCQ/CQ use who developed a COVID-19 infection through a comparison between individuals chronically using HCQ/CQ with those not taking these drugs. We performed a systematic review and meta-analysis of studies on PubMed, Embase, and Cochrane Central. We included full-length reports, prospective observational cohorts, and clinical trials of adult patients (aged ≥ 18 years) who were diagnosed with a COVID-19 infection. Case studies, case series, letters, comments, and editorials were excluded. The main outcome was all-cause mortality. This study is registered with PROSPERO (CRD42022341678). We identified 541 studies, of which 20 studies were included, comprising 236,997 patients. All-cause mortality was significantly lower in patients with prior chronic use of HCQ/CQ compared to those with no previous usage (OR 0.76; 95% CI 0.62-0.94; p = 0.01). There was a considerably lower incidence of hospitalization among patients with chronic HCQ/CQ use compared to their counterparts without HCQ/CQ usage (OR 0.80; 95% CI 0.65-0.99; p = 0.04). All-cause mortality and hospitalization were significantly lower in rheumatic patients with chronic HCQ/CQ use who developed a COVID-19 infection.
Appendix B Duration of HCQ/CQ treatment Duration of HCQ/CQ treatment reported in the studies:
Appendix D
Sensitivity Analysis A sensitivity analysis was executed by sequentially deleting each study and reanalyzing the pooled estimate for the remaining studies. The sensitivity analysis for the outcome of all-cause mortality did not show any noteworthy difference when deleting any of its studies. However, concerning the hospitalization outcome, the Ugarte-Gil study demonstrated a substantial influence on the pooled OR. Following the exclusion of this study, the pooled OR became 1.15 (95% CI 0.79-1.69; p = 0.46; I 2 = 0%). When it came to excluding any other study related to the hospitalization outcome, there was no significant impact on the OR result.
Appendix F The meta-regression performed on the outcome of all-cause mortality related to the mean age of patients and the one related to the proportion of men showed a Chi 2 = 1.28, df = 7, Sig. = 0.989. The meta-regression on the outcome of hospitalization related to the mean age showed a Chi 2 = 2.65, df = 10, Sig. = 0.989. The one performed for the proportion of men resulted in a Chi 2 = 6.22, df = 10, Sig. = 0.797.
Appendix G Forest Plots with Fixed-Effect
Appendix F The meta-regression performed on the outcome of all-cause mortality related to the mean age of patients and the one related to the proportion of men showed a Chi 2 = 1.28, df = 7, Sig. = 0.989. The meta-regression on the outcome of hospitalization..
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