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