Abstract: Retrospective Clinical Research Report Effect of chronic hydroxychloroquine use on COVID-19 risk in patients with rheumatoid arthritis and systemic lupus erythematosus: a multicenter retrospective cohort Journal of International Medical Research 50(4) 1–13 ! The Author(s) 2022 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/03000605221090363 journals.sagepub.com/home/imr Ismail A. Walbi1, Hassan A. Albarqi2, Nayef Saleh Alghanim3, Marzooq Abdullah Albadi4, Hesham Mohammed Al Maimouni5,6, Saad Ahmed Alkahtani1, Ali Mohamed Alshabi1, Amer S. Alali7, Faleh Alqahtani8, Amal Hassan Al-Najjar9, Mohammad A Hazzazi6,10, Deemah S Alanazi11, Abdulrahman Abdulaziz Sabei12, Omer S Alsaweed13, Rahaf K Alajra13 and Hussain Alqhtani1 8 1 Department of Clinical Pharmacy, College of Pharmacy, Najran University, Najran, Saudi Arabia 2 Department of Pharmaceutics, College of Pharmacy, Najran University, Najran, Saudi Arabia 3 Consultant, Rheumatology Department, King Saud Medical City, Riyadh, Saudi Arabia 4 Consultant internist and rheumatologist, Security Forces Hospital Program, Riyadh, Saudi Arabia 5 Consultant, Rheumatology, Division of Rheumatology, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia 6 Assistant Professor of Medicine, King Saud Bin Abdulaziz University of Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia 7 Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-kharj, 11942, Saudi Arabia Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia 9 Drug & Poison Information Center Supervisor, Security Forces Hospital Program, Riyadh, Saudi Arabia 10 Vitreoretinal Division, Department of Vitreoretinal, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11 Senior Pharmacist, Pharmaceutical Care Services, King Saud Medical City, Riyadh, Saudi Arabia 12 Senior Registrar, Ministry of Health, First Health cluster, Western Riyadh Dental Complex, Periodontic Division, Riyadh, Saudi Arabia 13 Laboratory Services, Security Forces Hospital Program, Riyadh, Saudi Arabia Corresponding author: Hussain Alqhtani, Department of Clinical Pharmacy, College of Pharmacy, Najran University, King Abdulaziz Road P.O. Box 1988, Najran, Saudi Arabia. Email: hmhalqhtani@nu.edu.sa Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 Journal of International Medical Research Abstract Objective: Hydroxychloroquine (HCQ) has been used during the coronavirus disease 2019 (COVID-19) pandemic because of its reported anti-viral activity. This study examined the association of chronic HCQ use with the incidence and complications of COVID-19. Methods: This retrospective cohort study included adults with rheumatoid arthritis and/or systemic lupus erythematosus who visited rheumatology clinics in three tertiary hospitals in Riyadh, Saudi Arabia between January 2019 and December 2020. Patients were categorized into two groups based on HCQ use. Data were obtained from the electronic health record and by..