Advances in Rheumatology (Oct 2021)

Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil

  • Gecilmara Salviato Pileggi,
  • Gilda Aparecida Ferreira,
  • Ana Paula Monteiro Gomides Reis,
  • Edgard Torres Reis-Neto,
  • Mirhelen Mendes Abreu,
  • Cleandro Pires Albuquerque,
  • Nafice Costa Araújo,
  • Ana Beatriz Bacchiega,
  • Dante Valdetaro Bianchi,
  • Blanca Bica,
  • Eloisa Duarte Bonfa,
  • Eduardo Ferreira Borba,
  • Danielle Christinne Soares Egypto Brito,
  • Ângela Luzia Branco Pinto Duarte,
  • Rafaela Cavalheiro Espírito Santo,
  • Paula Reale Fernandes,
  • Mariana Peixoto Guimarães,
  • Kirla Wagner Poti Gomes,
  • Adriana Maria Kakehasi,
  • Evandro Mendes Klumb,
  • Cristina Costa Duarte Lanna,
  • Claudia Diniz Lopes Marques,
  • Odirlei André Monticielo,
  • Licia Maria Henrique Mota,
  • Gabriela Araújo Munhoz,
  • Eduardo Santos Paiva,
  • Helena Lucia Alves Pereira,
  • José Roberto Provenza,
  • Sandra Lucia Euzébio Ribeiro,
  • Laurindo Ferreira Rocha Junior,
  • Camila Santana Justo Cintra Sampaio,
  • Vanderson Souza Sampaio,
  • Emília Inoue Sato,
  • Thelma Skare,
  • Viviane Angelina de Souza,
  • Valeria Valim,
  • Marcus Vinícius Guimarães Lacerda,
  • Ricardo Machado Xavier,
  • Marcelo Medeiros Pinheiro

DOI
https://doi.org/10.1186/s42358-021-00217-0
Journal volume & issue
Vol. 61, no. 1
pp. 1 – 11

Abstract

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Abstract Background 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. Methods 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. Results 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). Conclusion 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).

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