Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil
Open Access
- 7 October 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Advances in Rheumatology
- Vol. 61 (1), 1-11
- https://doi.org/10.1186/s42358-021-00217-0
Abstract
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. 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. 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 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 mg/ 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). 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. Trial registration Brazilian Registry of Clinical Trials (ReBEC; RBR – 9KTWX6).Keywords
Funding Information
- CNPq (403442/2020-6)
This publication has 88 references indexed in Scilit:
- 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndromeAnnals Of The Rheumatic Diseases, 2016
- Population Pharmacokinetics of Hydroxychloroquine in Japanese Patients With Cutaneous or Systemic Lupus ErythematosusTherapeutic Drug Monitoring, 2016
- Chikungunya, the emerging migratory rheumatismThe Lancet Infectious Diseases, 2015
- 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiativeAnnals Of The Rheumatic Diseases, 2013
- Effects of Hydroxychloroquine on Immune Activation and Disease Progression Among HIV-Infected Patients Not Receiving Antiretroviral TherapyJAMA, 2012
- Chloroquine for influenza prevention: a randomised, double-blind, placebo controlled trialThe Lancet Infectious Diseases, 2011
- 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiativeAnnals Of The Rheumatic Diseases, 2010
- Population Pharmacokinetics of Hydroxychloroquine in Patients With Rheumatoid ArthritisTherapeutic Drug Monitoring, 2003
- The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the handArthritis & Rheumatism, 1990