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0 0.5 1 1.5 2+ Case 6% Improvement Relative Risk HCQ for COVID-19  Salvarani et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective study in Italy No significant difference in cases Salvarani et al., Arthritis & Rheumato.., Aug 2020 Favors HCQ Favors control

Susceptibility to COVID-19 in Patients Treated With Antimalarials: A Population-Based Study in Emilia-Romagna, Northern Italy

Salvarani et al., Arthritis & Rheumatology, doi:10.1002/art.41475
Aug 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 422 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments.
Comparison of CQ/HCQ users with the general population in a region of Italy, showing no significant difference in the probability of COVID-19.
CQ/HCQ users were mostly systemic autoimmune disease patients and authors do not adjust for the very different baseline risk for these patients. Other research shows that the risk of COVID-19 for systemic autoimmune disease patients is much higher overall, Ferri et al. show OR 4.42, p<0.001 Ferri.
This study is excluded in the after exclusion results of meta analysis: not fully adjusting for the different baseline risk of systemic autoimmune patients.
risk of case, 6.0% lower, OR 0.94, p = 0.75, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Salvarani et al., 6 Aug 2020, retrospective, population-based cohort, Italy, peer-reviewed, 18 authors.
This PaperHCQAll
Susceptibility to COVID-19 in Patients Treated With Antimalarials: A Population-Based Study in Emilia-Romagna, Northern Italy
MD Carlo Salvarani, Pamela Mancuso, MD Federica Gradellini, Nilla Viani, Paolo Pandolfi, Massimo Reta, Giuliano Carrozzi, Gilda Sandri, MD Gianluigi Bajocchi, Elena Galli, MD Francesco Muratore, MD Luigi Boiardi, MD Nicolò Pipitone, Giulia Cassone, MB Stefania Croci, Anna Maria Marata, MD Massimo Costantini, MD Paolo Giorgi Rossi, : Azienda, Unità Operativa, Roberto Grilli, Massimiliano Marino, Giulio Formoso, Debora Formisano, Manuela Bedeschi, Cinzia Perilli, Elisabetta Larosa, Eufemia Bisaccia, Ivano Venturi, Massimo Vicentini, Cinzia Campari, Francesco Gioia, Serena Broccoli, Marta Ottone, Pierpaolo Pattacini, Giulia Besutti, Valentina Iotti, Lucia Spaggiari, Chiara Seidenari, Licia Veronesi, Paola Affanni, Maria Eugenia Colucci, Andrea Nitrosi, Marco Foracchia, Rossana Colla, Alessandro Zerbini, Marco Massari, Anna Maria Ferrari, Mirco Pinotti, Nicola Facciolongo, Ivana Lattuada, Laura Trabucco, Stefano De Pietri, Giorgio Francesco Danelli, Laura Albertazzi, Enrica Bellesia, Simone Canovi, Mattia Corradini, Tommaso Fasano, Elena Magnani, Annalisa Pilia, Alessandra Polese, Silvia Storchi Incerti, Piera Zaldini, Efrem Bonelli, Bonanno Orsola, Matteo Revelli, Carmine Pinto, Francesco Venturelli
Objective. To evaluate the susceptibility to coronavirus disease 2019 in patients with autoimmune conditions treated with antimalarials in a population-based study. Methods. All residents treated with chloroquine (CQ)/hydroxychloroquine (HCQ) from July through December 2019 and living in 3 provinces of Regione Emilia-Romagna were identified by drug prescription registries and matched with the registry containing all residents living in the same areas who have had swabs and tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results. A total of 4,408 patients were identified. The prevalence of patients receiving antimalarials was 0.85 per 1,000 men and 3.3 per 1,000 women. The cumulative incidence of testing during the study period was 2.7% in the general population and 3.8% among those receiving CQ or HCQ, while the cumulative incidence of testing positive was 0.55% in the general population and 0.70% among those receiving CQ/HCQ. Multivariate models showed that those receiving CQ/HCQ had a slightly higher probability of being tested compared to the general population (OR 1.09 [95% CI 0.94-1.28]), the same probability of being diagnosed as having COVID-19 (OR 0.94 [95% CI 0.66-1.34]), and a slightly lower probability of being positive once tested (OR 0.83 [95% CI 0.56-1.23]). None of the differences were significant. Conclusion. Our findings do not support the use of antimalarials as a prophylactic treatment of COVID-19.
AUTHOR CONTRIBUTIONS All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published. Dr. Salvarani had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design. Salvarani, Sandri, Bajocchi, Galli, Muratore, Boiardi, Pipitone, Cassone, Croci, Marata, Costantini. Acquisition of data. Salvarani, Gradellini, Viani, Pandolfi, Reta, Carrozzi, Rossi. Analysis and interpretation of data. Mancuso. and anticardiolipin (aCL) autoantibodies were measured by enzyme-linked immunosorbent assay in serum samples from 56 COVID-19 patients who were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction." The sentence "Except for 1 patient who presented with a history of stroke, no other IgG aCL-positive patient with a severe manifestation of COVID-19 presented with a history of thrombosis, which suggests that positivity for aCL could be attributed to infection with SARS-CoV-2" (page 1954, right column) should have read "Except for 1 patient who presented with a history of stroke, no other IgG aCL-positive patient with a severe manifestation of COVID-19 presented with a history of thrombosis, which suggests that positivity for aCL could be attributed to severe infection with SARS-CoV-2." ..
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