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All Studies   Meta Analysis    Recent:   
0 0.5 1 1.5 2+ Death/intubation, SLE an.. 41% Improvement Relative Risk Death/intubation, SLE 65% Death/intubation, RA 0% HCQ for COVID-19  Scirocco et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 627 patients in Italy Lower death/intubation with HCQ (not stat. sig., p=0.38) c19hcq.org Scirocco et al., Lupus Science & Medic.., Oct 2023 Favors HCQ Favors control

COVID-19 prognosis in systemic lupus erythematosus compared with rheumatoid arthritis and spondyloarthritis: results from the CONTROL-19 Study by the Italian Society for Rheumatology

Scirocco et al., Lupus Science & Medicine, doi:10.1136/lupus-2023-000945
Oct 2023  
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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.
4,100+ studies for 60+ treatments. c19hcq.org
Retrospective 103 SLE and 524 RA patients in Italy, showing significantly lower mortality/ventilation with HCQ use for SLE patients, and no significant difference for RA patients in unadjusted results.
Authors did not include HCQ in multivariable analysis, only including four variables "chosen among the most clinically relevant". Multivariable analysis may significantly improve results for RA patients because HCQ use may correlate with more severe disease due to use for patients that failed or do not tolerate first-line therapies.
It is not clear how the patients were selected - the very high ~25% ventilation/mortality suggests that most were hospitalized COVID-19 patients, in which case any benefit of HCQ in reducing hospitalizations will not be reflected in the results.
Authors falsely state that "subsequent studies have definitely proved that [HCQ] is not linked to COVID-19 prognosis", suggesting significant bias, and possibily indicating why HCQ was excluded in the reported multivariable results. While such a negative statement is reasonable based on the evidence for very late stage high dose treatment, studies for early treatment and prophylaxis do not match. In reality, 73% of all studies show a positive effect, and 94% of early treatment and 82% of prophylaxis studies show a positive effect. 145 controlled studies show statistically significant positive results for one or more outcomes (including 11 RCTs) c19hcq.org.
risk of death/intubation, 41.3% lower, OR 0.59, p = 0.38, treatment 183, control 444, meta analysis of SLE and RA, RR approximated with OR.
risk of death/intubation, 65.0% lower, OR 0.35, p = 0.03, treatment 71, control 32, SLE, RR approximated with OR.
risk of death/intubation, no change, OR 1.00, p = 0.87, treatment 112, control 412, RA, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Scirocco et al., 17 Oct 2023, retrospective, Italy, peer-reviewed, mean age 48.9, 14 authors.
This PaperHCQAll
COVID-19 prognosis in systemic lupus erythematosus compared with rheumatoid arthritis and spondyloarthritis: results from the CONTROL-19 Study by the Italian Society for Rheumatology
Chiara Scirocco, Sara Ferrigno, Laura Andreoli, Micaela Fredi, Claudia Lomater, Luca Moroni, Marta Mosca, Bernd Raffeiner, Greta Carrara, Gianpiero Landolfi, Davide Rozza, Anna Zanetti, Carlo Alberto Scirè, Gian Domenico Sebastiani
Lupus Science & Medicine, doi:10.1136/lupus-2023-000945
Introduction Data concerning SARS-CoV-2 in patients affected by SLE are contradicting. The aim of this study was to investigate disease-related differences in COVID-19 prognosis of patients affected by rheumatic diseases before vaccination; we tested the hypothesis that patients with SLE may have a different outcome compared with those with rheumatoid arthritis (RA) or spondyloarthritis (SPA). Methods We analysed data from the national CONTROL-19 Database with a retrospective, observational design, including rheumatic patients affected by COVID-19. The principal outcome measure was hospitalisation with death or mechanical ventilation. Differences between SLE, RA and SPA were analysed by univariable and multivariable logistic regression models. Results We included 103 patients with SLE (88.2% female, mean age 48.9 years, 50.4% active disease), 524 patients with RA (74.4% female, mean age 60.6 years, 59.7% active disease) and 486 patients with SPA (58.1% female, mean age 53.2 years, 58% active disease). Outcome prevalence was not different between patients with SLE and those with RA (SLE 24.5%, RA 25.6%), while patients with SPA showed a more favourable outcome compared with those with SLE (SPA 15.9%); data from the multivariable analysis confirmed this result. In SLE, age >65 years (OR 17.3, CI 5.51 to 63.16, p<0.001), hypertension (OR 6.2, CI 2.37 to 17.04, p<0.001) and prednisone (PDN) use (OR 3.8, CI 1.43 to 11.39, p=0.01) were associated with severe outcomes, whereas hydroxychloroquine use was found to be protective (OR 0.3, CI 0.14 to 0.91, p=0.03). Conclusion Our data suggest that patients with SLE and RA do not show a different COVID-19 outcome, while patients with SPA have a more favourable disease course compared with those with SLE. Risk of hospitalisation with ventilation or death was associated with age >65 years, hypertension and PDN use in patients with SLE. WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ COVID-19 expression in rheumatic diseases has been largely studied in the last 3 years. Some studies reported an increased risk of severe COVID-19 in these patients, while others did not confirm these data. Concerning patients with SLE, data on COVID-19 incidence and prognosis come mainly from case series, reports, observational and retrospective studies, and evidence is controversial. Moreover, little has been investigated about the comparison between SLE and other rheumatic diseases concerning COVID-19 outcome. WHAT THIS STUDY ADDS ⇒ We analysed the national surveillance study's data promoted by the Italian Society for Rheumatology (CONTROL-19 Database) including patients with rheumatic diseases and COVID-19. The principal outcome measure was hospitalisation with death or mechanical ventilation. We included 103 patients with SLE, 524 patients with rheumatoid arthritis (RA) and 486 patients with spondyloarthritis (SPA). According to our results, outcome prevalence was not different between patients with SLE and those with RA,..
Contributors CS, SF, DR, GL, AZ, MM, CAS and GDS were responsible for data analysis and interpretation and gave substantial contribution to the conception of the work. CS, SF, LA, MF, CL, LM, MM, BR, GC, GL, DR, AZ, CAS and GDS wrote the original draft and revised it. CS, SF, MM, CAS and GDS realised and validated the final revision and agreed about all the aspects of the work ensuring that questions related to the accuracy or integrity of it were appropriately investigated. GDS is responsible for the overall content as the guarantor. All authors reviewed and approved the manuscript's content before submission. Competing interests None declared. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Patient consent for publication Not required. Ethics approval This study involves human participants and was approved by the Ethics Committee of Area Vasta Emilia Centrale on 24 March 2020 (288/2020/Oss/ AOUFe). Encrypted retrospective information was used. Provenance and peer review Not commissioned; externally peer reviewed.
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Differences between SLE, RA and SPA were analysed by ' 'univariable and multivariable logistic regression ' 'models.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included 103 ' 'patients with SLE (88.2% female, mean age 48.9 years, 50.4% active disease), 524 patients ' 'with RA (74.4% female, mean age 60.6 years, 59.7% active disease) and 486 patients with SPA ' '(58.1% female, mean age 53.2 years, 58% active disease).</jats:p><jats:p>Outcome prevalence ' 'was not different between patients with SLE and those with RA (SLE 24.5%, RA 25.6%), while ' 'patients with SPA showed a more favourable outcome compared with those with SLE (SPA 15.9%); ' 'data from the multivariable analysis confirmed this result.</jats:p><jats:p>In SLE, age ' '&gt;65 years (OR 17.3, CI 5.51 to 63.16, p&lt;0.001), hypertension (OR 6.2, CI 2.37 to 17.04, ' 'p&lt;0.001) and prednisone (PDN) use (OR 3.8, CI 1.43 to 11.39, p=0.01) were associated with ' 'severe outcomes, whereas hydroxychloroquine use was found to be protective (OR 0.3, CI 0.14 ' 'to 0.91, p=0.03).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Our ' 'data suggest that patients with SLE and RA do not show a different COVID-19 outcome, while ' 'patients with SPA have a more favourable disease course compared with those with SLE. 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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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