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All Studies   Meta Analysis    Recent:   

Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil

Pileggi et al., Advances in Rheumatology, doi:10.1186/s42358-021-00217-0
Oct 2021  
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Case -10% Improvement Relative Risk HCQ for COVID-19  Pileggi et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 9,589 patients in Brazil (March - May 2020) No significant difference in cases c19hcq.org Pileggi et al., Advances in Rheumatology, Oct 2021 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 417 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,800+ studies for 102 treatments. c19hcq.org
Cross-sectional study of 5,166 rheumatic disease patients on HCQ and 4,423 non-rheumatic disease household contacts in Brazil showing no significant difference in COVID-19 diagnosis.
The analysis in this study is not logical. Rheumatic disease patients have higher risk of infections1-7. Ferri et al. show COVID-19 OR 4.42, p<0.001 for systemic autoimmune disease patients8. 82.5% of patients in this study had SLE.
Studies typically compare rheumatic disease patients with and without HCQ, adjusting for details of the diseases. In this study, authors specifically exclude rheumatic disease patients not on HCQ, and compare with a different population of non-rheumatic diseases patients without making adjustments for the very different baseline risk for rheumatic diseases.
Authors found significantly higher risk for women, contradicting other results. This supports bias due to the different risk for rheumatic disease patients (more likely to be women, more likely to have higher risk due to rheumatic disease as opposed to gender).
Similarly, authors find a significantly lower risk of COVID-19 with increasing age. The household contact group had a higher mean age and standard deviation, suggesting a significantly larger proportion of older individuals in that group. The observed lower risk with increasing age is likely influenced by the fact that older participants were more often non-RD household contacts, who inherently had a lower baseline risk compared to rheumatic disease patients.
This study is excluded in the after exclusion results of meta analysis: excluding more comparable RD patients not on HCQ, not adjusting for the different baseline risk of RD patients.
risk of case, 10.0% higher, OR 1.10, p = 0.53, treatment 5,166, control 4,423, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Pileggi et al., 7 Oct 2021, retrospective, Brazil, peer-reviewed, 39 authors, study period 29 March, 2020 - 17 May, 2020. Contact: gildaferreira9@gmail.com (corresponding author).
This PaperHCQAll
Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil
Gecilmara Salviato Pileggi, Gilda Aparecida Ferreira, Ana Paula Monteiro Gomides Reis, Edgard Torres Reis-Neto, Mirhelen Mendes Abreu, Cleandro Pires Albuquerque, Nafice Costa Araújo, Ana Beatriz Bacchiega, Dante Valdetaro Bianchi, Blanca Bica, Eloisa Duarte Bonfa, Eduardo Ferreira Borba, Danielle Christinne Soares Egypto Brito, Ângela Luzia Branco Pinto Duarte, Rafaela Cavalheiro Espírito Santo, Paula Reale Fernandes, Mariana Peixoto Guimarães, Kirla Wagner Poti Gomes, Adriana Maria Kakehasi, Evandro Mendes Klumb, Cristina Costa Duarte Lanna, Claudia Diniz Lopes Marques, Odirlei André Monticielo, Licia Maria Henrique Mota, Gabriela Araújo Munhoz, Eduardo Santos Paiva, Helena Lucia Alves Pereira, José Roberto Provenza, Sandra Lucia Euzébio Ribeiro, Laurindo Ferreira Rocha Junior, Camila Santana Justo Cintra Sampaio, Vanderson Souza Sampaio, Emília Inoue Sato, Thelma Skare, Viviane Angelina De Souza, Valeria Valim, Marcus Vinícius Guimarães Lacerda, Ricardo Machado Xavier, Marcelo Medeiros Pinheiro
Advances in Rheumatology, doi:10.1186/s42358-021-00217-0
Background: There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods: This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann-Whitney, Chisquare and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the presence of COVID-19. Results: From March 29th to May 17st, 2020, a total of 10,443 participants were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren's syndrome and 0.8% systemic sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30 days prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant difference between
Authors' contributions MMP, GSP, LHMH, GAF, CDLM, AMK, RMX, APMGR, ESP, ETRN, defined as Steering Committee, and MVGL conceived the study, developed the protocol and wrote the manuscript with input from all other authors. In addition, all authors are responsible for collecting data and processing, management them and statistical analysis. All authors read and approved the final manuscript. Declarations Ethics approval and consent to participate This protocol was approved by the Brazilian Committee of Ethics in Human Research -CONEP on March 27 th , 2020 (CAAE 30246120.3.1001.5505). The informed consent process was conducted by phone, as CONEP waived the requirement for the written informed consent form due to the COVID-19 social distancing constraints. This study was registered at the Brazilian Registry of Clinical Trials (ReBEC; RBR -9KTWX6). All sections are in accordance with STROBE guidelines. Consent for publication The consent of publication was given together with the consent of participation fol all participants and Investigators. Competing interests The authors declare that they have no competing interests. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Our aim was to compare the occurrence of ' 'COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the ' 'same household not taking the drug during the first 8\xa0weeks of community viral ' 'transmission in Brazil.\n' '</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>This baseline cross-sectional analysis is part of a 24-week ' 'observational multi-center study involving 22 Brazilian academic outpatient centers. All ' 'information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were ' 'recorded on a specific web-based platform using telephone calls from physicians and medical ' 'students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. ' 'Mann–Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two ' 'binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise ' 'method for the presence of COVID-19.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>From March 29th to May 17st, 2020, a total of 10,443 participants ' 'were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic ' 'erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren’s syndrome and 0.8% systemic ' 'sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30\xa0days ' 'prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant ' 'difference between rheumatic disease patients (4.03%) and controls (3.25%). After adjustments ' 'for multiple confounders, the main risk factor significantly associated with a COVID-19 ' 'diagnosis was lung disease (OR 1.63; 95% CI 1.03–2.58); and for rheumatic disease patients ' 'were diagnosis of systemic sclerosis (OR 2.8; 95% CI 1.19–6.63) and glucocorticoids above ' '10\xa0mg/ day (OR 2.05; 95% CI 1.31–3.19). In addition, a recent influenza vaccination had a ' 'protective effect (OR 0.674; 95% CI 0.46–0.98).</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusion</jats:title>\n' ' <jats:p>Patients with rheumatic disease on hydroxychloroquine presented a ' 'similar occurrence of COVID-19 to household cohabitants, suggesting a lack of any protective ' 'role against SARS-CoV-2 infection.</jats:p>\n' ' <jats:p><jats:italic>Trial registration</jats:italic> Brazilian Registry of ' 'Clinical Trials (ReBEC; RBR – 9KTWX6).</jats:p>\n' ' </jats:sec>', 'DOI': '10.1186/s42358-021-00217-0', 'type': 'journal-article', 'created': {'date-parts': [[2021, 10, 7]], 'date-time': '2021-10-07T14:07:57Z', 'timestamp': 1633615677000}, 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 7, 'title': 'Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients ' 'with rheumatic diseases in Brazil', 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' 'SARS-CoV-2 infection in patients with autoimmune rheumatic diseases in ' 'northeast Italy: a cross-sectional study on 916 patients. J Autoimmun. ' '2020;112:102502.', 'journal-title': 'J Autoimmun'}, { 'issue': '6', 'key': '217_CR40', 'doi-asserted-by': 'publisher', 'first-page': '839', 'DOI': '10.1136/annrheumdis-2020-217322', 'volume': '79', 'author': 'G Figueroa-Parra', 'year': '2020', 'unstructured': 'Figueroa-Parra G, Aguirre-Garcia GM, Gamboa-Alonso CM, Camacho-Ortiz A, ' 'Galarza-Delgado DA. Are my patients with rheumatic diseases at higher ' 'risk of COVID-19? Ann Rheum Dis. 2020;79(6):839–40.', 'journal-title': 'Ann Rheum Dis'}, { 'issue': '7', 'key': '217_CR41', 'doi-asserted-by': 'publisher', 'first-page': '859', 'DOI': '10.1136/annrheumdis-2020-217871', 'volume': '79', 'author': 'M Gianfrancesco', 'year': '2020', 'unstructured': 'Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila MI, Gossec L, ' 'et al. 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' 'COVID-19 in patients with rheumatic diseases: what is the real mortality ' 'risk? Ann Rheum Dis. 2020. ' 'https://doi.org/10.1136/annrheumdis-2020-218431.', 'journal-title': 'Ann Rheum Dis'}, { 'issue': '3', 'key': '217_CR44', 'doi-asserted-by': 'publisher', 'first-page': '155', 'DOI': '10.1038/s41584-020-0372-x', 'volume': '16', 'author': 'E Schrezenmeier', 'year': '2020', 'unstructured': 'Schrezenmeier E, Dorner T. Mechanisms of action of hydroxychloroquine ' 'and chloroquine: implications for rheumatology. Nat Rev Rheumatol. ' '2020;16(3):155–66.', 'journal-title': 'Nat Rev Rheumatol'}, { 'issue': '10229', 'key': '217_CR45', 'doi-asserted-by': 'publisher', 'first-page': '1011', 'DOI': '10.1016/S0140-6736(20)30686-3', 'volume': '395', 'author': 'L The', 'year': '2020', 'unstructured': 'The L. COVID-19: learning from experience. Lancet. 2020;395(10229):1011.', 'journal-title': 'Lancet'}, { 'issue': '17', 'key': '217_CR46', 'doi-asserted-by': 'publisher', 'first-page': 'e37', 'DOI': '10.1056/NEJMe2007263', 'volume': '382', 'author': 'HV Fineberg', 'year': '2020', 'unstructured': 'Fineberg HV. Ten weeks to crush the curve. N Engl J Med. ' '2020;382(17):e37.', 'journal-title': 'N Engl J Med'}, { 'issue': '14', 'key': '217_CR47', 'doi-asserted-by': 'publisher', 'first-page': '411', 'DOI': '10.15585/mmwr.mm6914e1', 'volume': '69', 'author': 'WE Wei', 'year': '2020', 'unstructured': 'Wei WE, Li Z, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic ' 'transmission of SARS-CoV-2 - Singapore, January 23–March 16, 2020. MMWR ' 'Morb Mortal Wkly Rep. 2020;69(14):411–5.', 'journal-title': 'MMWR Morb Mortal Wkly Rep'}, { 'issue': '2', 'key': '217_CR48', 'doi-asserted-by': 'publisher', 'first-page': 'e9', 'DOI': '10.1056/NEJMc2020836', 'volume': '383', 'author': 'M Klompas', 'year': '2020', 'unstructured': 'Klompas M, Morris CA, Shenoy ES. Universal masking in the Covid-19 era. ' 'N Engl J Med. 2020;383(2):e9.', 'journal-title': 'N Engl J Med'}, { 'issue': '21', 'key': '217_CR49', 'doi-asserted-by': 'publisher', 'first-page': 'e63', 'DOI': '10.1056/NEJMp2006372', 'volume': '382', 'author': 'M Klompas', 'year': '2020', 'unstructured': 'Klompas M, Morris CA, Sinclair J, Pearson M, Shenoy ES. Universal ' 'masking in hospitals in the Covid-19 Era. N Engl J Med. ' '2020;382(21):e63.', 'journal-title': 'N Engl J Med'}, { 'issue': '2', 'key': '217_CR50', 'doi-asserted-by': 'publisher', 'first-page': 'taaa020', 'DOI': '10.1093/jtm/taaa020', 'volume': '27', 'author': 'A Wilder-Smith', 'year': '2020', 'unstructured': 'Wilder-Smith A, Freedman DO. Isolation, quarantine, social distancing ' 'and community containment: pivotal role for old-style public health ' 'measures in the novel coronavirus (2019-nCoV) outbreak. J Travel Med. ' '2020;27(2):taaa020. https://doi.org/10.1093/jtm/taaa020.', 'journal-title': 'J Travel Med'}, { 'issue': '9', 'key': '217_CR51', 'doi-asserted-by': 'publisher', 'first-page': '677', 'DOI': '10.1016/S1473-3099(11)70065-2', 'volume': '11', 'author': 'NI Paton', 'year': '2011', 'unstructured': 'Paton NI, Lee L, Xu Y, Ooi EE, Cheung YB, Archuleta S, et al. ' 'Chloroquine for influenza prevention: a randomised, double-blind, ' 'placebo controlled trial. Lancet Infect Dis. 2011;11(9):677–83.', 'journal-title': 'Lancet Infect Dis'}, { 'issue': '4', 'key': '217_CR52', 'doi-asserted-by': 'publisher', 'first-page': '353', 'DOI': '10.1001/jama.2012.6936', 'volume': '308', 'author': 'NI Paton', 'year': '2012', 'unstructured': 'Paton NI, Goodall RL, Dunn DT, Franzen S, Collaco-Moraes Y, Gazzard BG, ' 'et al. Effects of hydroxychloroquine on immune activation and disease ' 'progression among HIV-infected patients not receiving antiretroviral ' 'therapy: a randomized controlled trial. JAMA. 2012;308(4):353–61.', 'journal-title': 'JAMA'}, { 'key': '217_CR53', 'doi-asserted-by': 'publisher', 'first-page': '1386', 'DOI': '10.1136/annrheumdis-2020-217690', 'volume': '79', 'author': 'MF Konig', 'year': '2020', 'unstructured': 'Konig MF, Kim AH, Scheetz MH, Graef ER, Liew JW, Simard J, et al. ' 'Baseline use of hydroxychloroquine in systemic lupus erythematosus does ' 'not preclude SARS-CoV-2 infection and severe COVID-19. Ann Rheum Dis. ' '2020;79:1386–8.', 'journal-title': 'Ann Rheum Dis'}, { 'issue': '6', 'key': '217_CR54', 'doi-asserted-by': 'publisher', 'first-page': '671', 'DOI': '10.1097/00007691-200312000-00005', 'volume': '25', 'author': 'SJ Carmichael', 'year': '2003', 'unstructured': 'Carmichael SJ, Charles B, Tett SE. Population pharmacokinetics of ' 'hydroxychloroquine in patients with rheumatoid arthritis. Ther Drug ' 'Monit. 2003;25(6):671–81.', 'journal-title': 'Ther Drug Monit'}, { 'issue': '2', 'key': '217_CR55', 'doi-asserted-by': 'publisher', 'first-page': '259', 'DOI': '10.1097/FTD.0000000000000261', 'volume': '38', 'author': 'S Morita', 'year': '2016', 'unstructured': 'Morita S, Takahashi T, Yoshida Y, Yokota N. Population pharmacokinetics ' 'of hydroxychloroquine in Japanese patients with cutaneous or systemic ' 'lupus erythematosus. Ther Drug Monit. 2016;38(2):259–67.', 'journal-title': 'Ther Drug Monit'}, { 'key': '217_CR56', 'doi-asserted-by': 'publisher', 'first-page': '427', 'DOI': '10.2174/1389200221666200610172929', 'volume': '21', 'author': 'C Cui', 'year': '2020', 'unstructured': 'Cui C, Tu S, En VSJ, Li X, Yao X, Li H, et al. Review on the clinical ' 'pharmacology of hydroxychloroquine sulfate for the treatment of ' 'COVID-19. Curr Drug Metab. 2020;21:427–35.', 'journal-title': 'Curr Drug Metab'}, { 'issue': '15', 'key': '217_CR57', 'doi-asserted-by': 'publisher', 'first-page': '732', 'DOI': '10.1093/cid/ciaa237', 'volume': '71', 'author': 'X Yao', 'year': '2020', 'unstructured': 'Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. 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. 2020;71(15):732–9.', 'journal-title': 'Clin Infect Dis'}, { 'issue': '10226', 'key': '217_CR58', 'doi-asserted-by': 'publisher', 'first-page': 'e42', 'DOI': '10.1016/S0140-6736(20)30418-9', 'volume': '395', 'author': 'C Calisher', 'year': '2020', 'unstructured': 'Calisher C, Carroll D, Colwell R, Corley RB, Daszak P, Drosten C, et al. ' 'Statement in support of the scientists, public health professionals, and ' 'medical professionals of China combatting COVID-19. Lancet. ' '2020;395(10226):e42–3.', 'journal-title': 'Lancet'}, { 'issue': '2', 'key': '217_CR59', 'doi-asserted-by': 'publisher', 'first-page': '156', 'DOI': '10.5582/bst.2020.03072', 'volume': '14', 'author': 'J Gao', 'year': '2020', 'unstructured': 'Gao J, Hu S. Update on use of chloroquine/hydroxychloroquine to treat ' 'coronavirus disease 2019 (COVID-19). Biosci Trends. 2020;14(2):156–8.', 'journal-title': 'Biosci Trends'}, { 'issue': '1', 'key': '217_CR60', 'doi-asserted-by': 'publisher', 'first-page': '72', 'DOI': '10.5582/bst.2020.01047', 'volume': '14', 'author': 'J Gao', 'year': '2020', 'unstructured': 'Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown ' 'apparent efficacy in treatment of COVID-19 associated pneumonia in ' 'clinical studies. Biosci Trends. 2020;14(1):72–3.', 'journal-title': 'Biosci Trends'}, { 'issue': '5', 'key': '217_CR61', 'doi-asserted-by': 'publisher', 'first-page': '667', 'DOI': '10.1136/annrheumdis-2020-217424', 'volume': '79', 'author': 'S Monti', 'year': '2020', 'unstructured': 'Monti S, Balduzzi S, Delvino P, Bellis E, Quadrelli VS, Montecucco C. ' 'Clinical course of COVID-19 in a series of patients with chronic ' 'arthritis treated with immunosuppressive targeted therapies. 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Sci ' 'Rep. 2019;9(1):9704.', 'journal-title': 'Sci Rep'}, { 'issue': '12', 'key': '217_CR67', 'doi-asserted-by': 'publisher', 'first-page': '1043', 'DOI': '10.1080/1744666X.2018.1538789', 'volume': '14', 'author': 'V Ocampo-Piraquive', 'year': '2018', 'unstructured': 'Ocampo-Piraquive V, Nieto-Aristizabal I, Canas CA, Tobon GJ. Mortality ' 'in systemic lupus erythematosus: causes, predictors and interventions. ' 'Expert Rev Clin Immunol. 2018;14(12):1043–53.', 'journal-title': 'Expert Rev Clin Immunol'}, { 'issue': '3', 'key': '217_CR68', 'doi-asserted-by': 'publisher', 'first-page': '403', 'DOI': '10.1002/art.40729', 'volume': '71', 'author': 'A Jorge', 'year': '2019', 'unstructured': 'Jorge A, Wallace ZS, Zhang Y, Lu N, Costenbader KH, Choi HK. All-cause ' 'and cause-specific mortality trends of end-stage renal disease due to ' 'lupus nephritis from 1995 to 2014. Arthritis Rheumatol. ' '2019;71(3):403–10.', 'journal-title': 'Arthritis Rheumatol'}, { 'issue': '4', 'key': '217_CR69', 'doi-asserted-by': 'publisher', 'first-page': '424', 'DOI': '10.1002/jmv.25685', 'volume': '92', 'author': 'G Li', 'year': '2020', 'unstructured': 'Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections ' 'and immune responses. J Med Virol. 2020;92(4):424–32.', 'journal-title': 'J Med Virol'}, { 'issue': '3', 'key': '217_CR70', 'doi-asserted-by': 'publisher', 'first-page': '428', 'DOI': '10.1111/bjh.16659', 'volume': '189', 'author': 'S Wan', 'year': '2020', 'unstructured': 'Wan S, Yi Q, Fan S, Lv J, Zhang X, Guo L, et al. Relationships among ' 'lymphocyte subsets, cytokines, and the pulmonary inflammation index in ' 'coronavirus (COVID-19) infected patients. Br J Haematol. ' '2020;189(3):428–37.', 'journal-title': 'Br J Haematol'}, { 'issue': '6', 'key': '217_CR71', 'doi-asserted-by': 'publisher', 'first-page': '724', 'DOI': '10.1136/annrheumdis-2020-217407', 'volume': '79', 'author': 'M Matucci-Cerinic', 'year': '2020', 'unstructured': 'Matucci-Cerinic M, Bruni C, Allanore Y, Clementi M, Dagna L, Damjanov ' 'NS, et al. Systemic sclerosis and the COVID-19 pandemic: World ' 'Scleroderma Foundation preliminary advice for patient management. Ann ' 'Rheum Dis. 2020;79(6):724–6.', 'journal-title': 'Ann Rheum Dis'}, { 'issue': '7', 'key': '217_CR72', 'doi-asserted-by': 'publisher', 'first-page': '2043', 'DOI': '10.1007/s10067-020-05193-2', 'volume': '39', 'author': 'M Orlandi', 'year': '2020', 'unstructured': 'Orlandi M, Lepri G, Bruni C, Wang Y, Bartoloni A, Zammarchi L, et al. ' 'The systemic sclerosis patient in the COVID-19 era: the challenging ' 'crossroad between immunosuppression, differential diagnosis and ' 'long-term psychological distress. 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Eur Arch Otorhinolaryngol. ' '2020;277(8):2251–61.', 'journal-title': 'Eur Arch Otorhinolaryngol'}, { 'issue': '1', 'key': '217_CR75', 'doi-asserted-by': 'publisher', 'first-page': '39', 'DOI': '10.1136/annrheumdis-2019-215882', 'volume': '79', 'author': 'V Furer', 'year': '2020', 'unstructured': 'Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, et ' 'al. 2019 update of EULAR recommendations for vaccination in adult ' 'patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. ' '2020;79(1):39–52.', 'journal-title': 'Ann Rheum Dis'}, { 'key': '217_CR76', 'unstructured': 'Epidemiologists CoSaT. Interm-20-ID-01: standardized surveillance case ' 'definitions and national notification for 2019 novel coronavirus disease ' '(COVID-19). 2020 2020.'}, { 'issue': '9', 'key': '217_CR77', 'doi-asserted-by': 'publisher', 'first-page': 'e557', 'DOI': '10.1016/S2665-9913(20)30227-7', 'volume': '2', 'author': 'J Zhong', 'year': '2020', 'unstructured': 'Zhong J, Shen G, Yang H, Huang A, Chen X, Dong L, et al. COVID-19 in ' 'patients with rheumatic disease in Hubei province, China: a multicentre ' 'retrospective observational study. Lancet Rheumatol. 2020;2(9):e557–64.', 'journal-title': 'Lancet Rheumatol'}, { 'issue': '9', 'key': '217_CR78', 'doi-asserted-by': 'publisher', 'first-page': '593', 'DOI': '10.1002/acr2.11084', 'volume': '1', 'author': 'Z Aouhab', 'year': '2019', 'unstructured': 'Aouhab Z, Hong H, Felicelli C, Tarplin S, Ostrowski RA. Outcomes of ' 'systemic lupus erythematosus in patients who discontinue ' 'hydroxychloroquine. ACR Open Rheumatol. 2019;1(9):593–9.', 'journal-title': 'ACR Open Rheumatol'}, { 'issue': '6', 'key': '217_CR79', 'doi-asserted-by': 'publisher', 'first-page': '787', 'DOI': '10.3899/jrheum.200395', 'volume': '47', 'author': 'CA Peschken', 'year': '2020', 'unstructured': 'Peschken CA. Possible consequences of a shortage of hydroxychloroquine ' 'for patients with systemic lupus erythematosus amid the COVID-19 ' 'Pandemic. J Rheumatol. 2020;47(6):787–90.', 'journal-title': 'J Rheumatol'}, { 'issue': '5', 'key': '217_CR80', 'doi-asserted-by': 'publisher', 'first-page': '632', 'DOI': '10.1038/s41591-020-0853-0', 'volume': '26', 'author': 'D Jakhar', 'year': '2020', 'unstructured': 'Jakhar D, Kaur I. Potential of chloroquine and hydroxychloroquine to ' 'treat COVID-19 causes fears of shortages among people with systemic ' 'lupus erythematosus. Nat Med. 2020;26(5):632.', 'journal-title': 'Nat Med'}, { 'issue': '6', 'key': '217_CR81', 'doi-asserted-by': 'publisher', 'first-page': '335', 'DOI': '10.1002/acr2.11148', 'volume': '2', 'author': 'K Michaud', 'year': '2020', 'unstructured': 'Michaud K, Wipfler K, Shaw Y, Simon TA, Cornish A, England BR, et al. ' 'Experiences of patients with rheumatic diseases in the United States ' 'during early days of the COVID-19 pandemic. ACR Open Rheumatol. ' '2020;2(6):335–43.', 'journal-title': 'ACR Open Rheumatol'}, { 'key': '217_CR82', 'doi-asserted-by': 'publisher', 'first-page': 'e23532', 'DOI': '10.2196/23532', 'volume': '9', 'author': 'A Gomides', 'year': '2020', 'unstructured': 'Gomides A. Impact of chronic use of antimalarials on SARS-CoV-2 ' 'infection in patients with immune-mediated rheumatic diseases: protocol ' 'design for a multicentric observational cohort in Brazil. JMIR Res ' 'Protoc. 2020;9:e23532.', 'journal-title': 'JMIR Res Protoc'}], 'container-title': 'Advances in Rheumatology', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1186/s42358-021-00217-0.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1186/s42358-021-00217-0/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1186/s42358-021-00217-0.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2021, 10, 7]], 'date-time': '2021-10-07T15:14:48Z', 'timestamp': 1633619688000}, 'score': 1, 'resource': { 'primary': { 'URL': 'https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-021-00217-0'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2021, 10, 7]]}, 'references-count': 82, 'journal-issue': {'issue': '1', 'published-print': {'date-parts': [[2021, 12]]}}, 'alternative-id': ['217'], 'URL': 'http://dx.doi.org/10.1186/s42358-021-00217-0', 'relation': {}, 'ISSN': ['2523-3106'], 'subject': [], 'container-title-short': 'Adv Rheumatol', 'published': {'date-parts': [[2021, 10, 7]]}, 'assertion': [ { 'value': '2 April 2021', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '14 September 2021', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '7 October 2021', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, {'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Declarations'}}, { 'value': 'This protocol was approved by the Brazilian Committee of Ethics in Human ' 'Research – CONEP on March 27<sup>th</sup>, 2020 (CAAE 30246120.3.1001.5505). ' 'The informed consent process was conducted by phone, as CONEP waived the ' 'requirement for the written informed consent form due to the COVID-19 social ' 'distancing constraints. This study was registered at the Brazilian Registry of ' 'Clinical Trials (ReBEC; RBR – 9KTWX6). All sections are in accordance with ' 'STROBE guidelines.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'The consent of publication was given together with the consent of participation ' 'fol all participants and Investigators.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent for publication'}}, { 'value': 'The authors declare that they have no competing interests.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '60'}
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