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COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and Meta-Analysis

Landsteiner de Sampaio Amêndola et al., Journal of Clinical Medicine, doi:10.3390/jcm11226865
Nov 2022  
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Mortality 24% Improvement Relative Risk Hospitalization 20% HCQ  Landsteiner de Sampaio Amêndola et al.  META ANALYSIS c19hcq.org 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 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
Systematic review and meta analysis of 20 studies on HCQ use in rheumatic disease patients, showing significantly lower mortality and hospitalization with HCQ prophylaxis.
8 meta analyses show significant improvements with hydroxychloroquine for mortality1-4, hospitalization1, recovery5, combined death/hospitalization/cases6, and cases7,8.
Currently there are 106 HCQ for COVID-19 pre-exposure prophylaxis studies, showing 30% lower mortality [14‑43%] and 28% fewer cases [20‑35%].
risk of death, 24.0% lower, OR 0.76, p = 0.010, RR approximated with OR.
risk of hospitalization, 20.0% lower, OR 0.80, p = 0.04, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Landsteiner de Sampaio Amêndola et al., 21 Nov 2022, peer-reviewed, 5 authors. Contact: isa.lands@hotmail.com (corresponding author).
This PaperHCQAll
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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