COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and Meta-Analysis
Landsteiner de Sampaio Amêndola et al.,
COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and Meta-Analysis,
Journal of Clinical Medicine, doi:10.3390/jcm11226865 (meta analysis)
Systematic review and meta analysis of 20 studies on HCQ use in rheumatic disease patients, showing significantly lower mortality and hospitalization with HCQ prophylaxis.
Currently there are
90 HCQ pre-exposure prophylaxis studies and meta analysis shows:
risk of death, 24.0% lower, OR 0.76, p = 0.010, RR approximated with OR.
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risk of hospitalization, 20.0% lower, OR 0.80, p = 0.04, RR approximated with OR.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Landsteiner de Sampaio Amêndola et al., 21 Nov 2022, peer-reviewed, 5 authors.
Contact:
isa.lands@hotmail.com (corresponding author).
Abstract: Journal of
Clinical Medicine
Review
COVID-19 Infection in Rheumatic Patients on Chronic
Antimalarial Drugs: A Systematic Review and Meta-Analysis
Isabela Landsteiner de Sampaio Amêndola 1, *, Jonathan Aires Pinheiro 2,3 , Pedro Póvoa 4,5,6 ,
Vicente Cés de Souza Dantas 7,8 and Rodrigo Bernardo Serafim 9,10
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5
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Citation: Landsteiner de Sampaio
Amêndola, I.; Aires Pinheiro, J.;
Póvoa, P.; Cés de Souza Dantas, V.;
Serafim, R.B. COVID-19 Infection in
Rheumatic Patients on Chronic
Antimalarial Drugs: A Systematic
Review and Meta-Analysis. J. Clin.
Med. 2022, 11, 6865. https://
doi.org/10.3390/jcm11226865
Academic Editor: Shunsuke Mori
Marilia Medical School, Marília 17519-030, Brazil
Health Sciences Center, University of Fortaleza, Fortaleza 60811-905, Brazil
Siupe Primary Care Facility, São Gonçalo do Amarante 62670-000, Brazil
NOVA Medical School, New University of Lisbon, 1169-056 Lisboa, Portugal
Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital,
5000 Odense, Denmark
Intensive Care Department, Hospital de São Francisco Xavier, CHLO, 1150-199 Lisboa, Portugal
Instituto D’or de Pesquisa e Ensino, Rio de Janeiro 22281-100, Brazil
Clinical Research Team, Hospital Naval Marcílio Dias, Rio de Janeiro 22281-100, Brazil
Intensive Care Unit, Hospital Copa D’or, Rio de Janeiro 22031-011, Brazil
Internal Medicine Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
Correspondence: isa.lands@hotmail.com; Tel.: +55-(19)99190-9911
Abstract: 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.
Received: 24 October 2022
Accepted: 18 November 2022
Published: 21 November 2022
Keywords: coronavirus disease-19; severe acute respiratory syndrome coronavirus 2; chloroquine;
hydroxychloroquine; rheumatic diseases
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