Research Article
Impact of the Long-Term Hydroxychloroquine Use on COVID-19 Severity in Patients with Autoimmune Rheumatic Disease
Abstract
Background-Aim: After the numerous studies, the clinical effectiveness of hydroxychloroquine (HCQ) against SARS-CoV-2 is now accepted limited. Besides this, HCQ has still been the first option in most rheumatology practices. To evaluate the frequency, severity and complication of COVID-19 in patients with autoimmune rheumatologic disease (ARD) receiving and not receiving long-term HCQ.
Methods: A total of 309 ARD patients were retrospectively evaluated for COVID-19 disease with a SARS-CoV-2 RT-PCR and IgM/IgG antibody.Patients were grouped as HCQ or non-HCQ groups. COVID-19 clinical symptoms development of viral pneumonia, rates of hospitalization, mortality due to COVID-19 and time from initial symptom to viral pneumonia, clinical recovery and RT-PCR negativity were evaluated.
Results: During the 13 month study period, 54 (17.4%) were diagnosed with COVID-19, the frequency of COVID-19 was similar between the HCQ (17.9%) and non-HCQ groups (16.7%), p=0.793. The frequency of the myalgia, arthralgia and sore throat were higher in the non-HCQ group, the frequency of other clinical signs and symptoms were higher in the HCQ group but none of them reached statistical significance. In all patients, viral pneumonia was diagnosed in 9 (16.7%), requiring hospitalization in 8 (14.8%), requiring oxygen therapy in 4 (7.4 %) patients and these severe COVID-19 clinical features were similar between groups. COVID-19 complications were seen in 2 patients, 1 of whom was mortality due to ARDS and one was supraventricular tachycardia but thromboembolism or rheumatologic disease activation were not observed.
Conclusions: As with the frequency of COVID-19, severity of COVID19 were similar between patients with and without long-term HCQ use in ARD. COVID 19 complications were found to be rare in our study.
References
- 1. Ferner RE, Aronson JK. Chloroquine and hydroxychloroquine in covid-19. BMJ 2020;369:m1432.
- 2. Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020;71:732-9.
- 3. Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med 2020;383:517-25.
- 4. Horby P, Mafham M, Linsell L, Bell JL, Staplin N, Emberson JR, et al. Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med 2020;383:2030-40.
- 5. Xie W, Wang Y, Zhang Z. Hydroxychloroquine reduces the risk of covid-19 in patients with rheumatic diseases: myth or reality? Ann Rheum Dis 2021;80:e6.
- 6. Zhu Y, Chen Y, Gong Y, Pan A, Ding H, Fang J, et al. Long-term application of hydroxychloroquine could not prevent the infection of COVID-19. J Infect Dev Ctries 2020;14:1368-73.
- 7. Gasmi A, Peana M, Noor S, Lysiuk R, Menzel A, Benahmed AG, et al. Chloroquine and hydroxychloroquine in the treatment of COVID-19: the never-ending story. Appl Microbiol Biotechnol 2021;105:1333-43.
- 8. Fajgenbaum DC, June CH. Cytokine Storm. N Engl J Med 2020;383:2255-73.
- 9. Tufan A, Avanoglu Guler A, Matucci-Cerinic M. COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs. Turk J Med Sci 2020;50:620-32.
- 10. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
- 11. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8:420-2.
- 12. Schrezenmeier E, Dorner T. Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol 2020;16:155-66.
- 13. Guidance To Covid-19 (SARS Cov2 Infection). [Accessed 21 April 2021, at https://covid19.saglik.gov.tr/TR-66299/covid-19-tedavi.html.]
- 14. Mitja O, Corbacho-Monne M, Ubals M, Alemany A, Suñer C, Tebé C, et al. A Cluster-Randomized Trial of Hydroxychloroquine for Prevention of Covid-19. N Engl J Med 2021;384:417-27.
- 15. Yang A, Guduguntla LS, Yang B. Potentials of Interferons and Hydroxychloroquine for the Prophylaxis and Early Treatment of COVID-19. J Cell Immunol 2020;2:333-40.
- 16. Revollo B, Tebe C, Penafiel J, Blanco I, Perez-Alvarez N, Lopez R, et al. Hydroxychloroquine pre-exposure prophylaxis for COVID-19 in healthcare workers. J Antimicrob Chemother 2021;76:827-9.
- 17. Ioannidis JPA. Infection fatality rate of COVID-19 inferred from seroprevalence data. Bull World Health Organ 2021;99:19-33F.
- 18. Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila MI, Gossec L, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859-66.
- 19. Mathian A, Mahevas M, Rohmer J, Roumier M, Cohen-Aubart F, Amador-Borrero B, et al. Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine. Ann Rheum Dis 2020;79:837-9.
- 20. Consortium FRSSSCI, contributors. Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: data from the French RMD COVID-19 cohort of 694 patients. Ann Rheum Dis 2020.
- 21. General Coronavirus Table. 2021. [Accessed 21 April 2021, at https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html.]
- 22. Rentsch CT, DeVito NJ, MacKenna B, Morton CE, Bhaskaran K, Brown JP, et al. Effect of pre-exposure use of hydroxychloroquine on COVID-19 mortality: a population-based cohort study in patients with rheumatoid arthritis or systemic lupus erythematosus using the OpenSAFELY platform. Lancet Rheumatol 2021;3:e19-e27.
- 23. Strangfeld A, Schafer M, Gianfrancesco MA, Lawson-Tovey S, Liew JW, Ljung L, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2021.
- 24. Esatoglu SN, Tascilar K, Babaoglu H, Bes C, Yurttas B, Akar S, et al. COVID-19 Among Patients With Inflammatory Rheumatic Diseases. Front Immunol 2021;12:651715.
- 25. Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med 2020;46:1089-98.
- 26. Moll M, Zon RL, Sylvester KW, Chen EC, Cheng V, Connell NT, et al. VTE in ICU Patients With COVID-19. Chest 2020;158:2130-5.
- 27. Gautret P, Hoang VT, Lagier JC, Raoult D. Effect of hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, an update with an intention-to-treat analysis and clinical outcomes. Int J Antimicrob Agents 2021;57:106239.
- 28. Omma A, Erden A, Apaydin H, Aslan M, Çamlı H, Şahiner ES, et al. Hydroxychloroquine shortened hospital stay and reduced intensive care unit admissions in hospitalized COVID-19 patients. The Journal of Infection in Developing Countries 2021.
- 29. Tang W, Cao Z, Han M, Wang Z, Chen J, Sun W, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ 2020;369:m1849.
Year 2024,
, 225 - 233, 01.07.2024
Abstract
References
- 1. Ferner RE, Aronson JK. Chloroquine and hydroxychloroquine in covid-19. BMJ 2020;369:m1432.
- 2. Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020;71:732-9.
- 3. Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med 2020;383:517-25.
- 4. Horby P, Mafham M, Linsell L, Bell JL, Staplin N, Emberson JR, et al. Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med 2020;383:2030-40.
- 5. Xie W, Wang Y, Zhang Z. Hydroxychloroquine reduces the risk of covid-19 in patients with rheumatic diseases: myth or reality? Ann Rheum Dis 2021;80:e6.
- 6. Zhu Y, Chen Y, Gong Y, Pan A, Ding H, Fang J, et al. Long-term application of hydroxychloroquine could not prevent the infection of COVID-19. J Infect Dev Ctries 2020;14:1368-73.
- 7. Gasmi A, Peana M, Noor S, Lysiuk R, Menzel A, Benahmed AG, et al. Chloroquine and hydroxychloroquine in the treatment of COVID-19: the never-ending story. Appl Microbiol Biotechnol 2021;105:1333-43.
- 8. Fajgenbaum DC, June CH. Cytokine Storm. N Engl J Med 2020;383:2255-73.
- 9. Tufan A, Avanoglu Guler A, Matucci-Cerinic M. COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs. Turk J Med Sci 2020;50:620-32.
- 10. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
- 11. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8:420-2.
- 12. Schrezenmeier E, Dorner T. Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol 2020;16:155-66.
- 13. Guidance To Covid-19 (SARS Cov2 Infection). [Accessed 21 April 2021, at https://covid19.saglik.gov.tr/TR-66299/covid-19-tedavi.html.]
- 14. Mitja O, Corbacho-Monne M, Ubals M, Alemany A, Suñer C, Tebé C, et al. A Cluster-Randomized Trial of Hydroxychloroquine for Prevention of Covid-19. N Engl J Med 2021;384:417-27.
- 15. Yang A, Guduguntla LS, Yang B. Potentials of Interferons and Hydroxychloroquine for the Prophylaxis and Early Treatment of COVID-19. J Cell Immunol 2020;2:333-40.
- 16. Revollo B, Tebe C, Penafiel J, Blanco I, Perez-Alvarez N, Lopez R, et al. Hydroxychloroquine pre-exposure prophylaxis for COVID-19 in healthcare workers. J Antimicrob Chemother 2021;76:827-9.
- 17. Ioannidis JPA. Infection fatality rate of COVID-19 inferred from seroprevalence data. Bull World Health Organ 2021;99:19-33F.
- 18. Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila MI, Gossec L, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859-66.
- 19. Mathian A, Mahevas M, Rohmer J, Roumier M, Cohen-Aubart F, Amador-Borrero B, et al. Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine. Ann Rheum Dis 2020;79:837-9.
- 20. Consortium FRSSSCI, contributors. Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: data from the French RMD COVID-19 cohort of 694 patients. Ann Rheum Dis 2020.
- 21. General Coronavirus Table. 2021. [Accessed 21 April 2021, at https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html.]
- 22. Rentsch CT, DeVito NJ, MacKenna B, Morton CE, Bhaskaran K, Brown JP, et al. Effect of pre-exposure use of hydroxychloroquine on COVID-19 mortality: a population-based cohort study in patients with rheumatoid arthritis or systemic lupus erythematosus using the OpenSAFELY platform. Lancet Rheumatol 2021;3:e19-e27.
- 23. Strangfeld A, Schafer M, Gianfrancesco MA, Lawson-Tovey S, Liew JW, Ljung L, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2021.
- 24. Esatoglu SN, Tascilar K, Babaoglu H, Bes C, Yurttas B, Akar S, et al. COVID-19 Among Patients With Inflammatory Rheumatic Diseases. Front Immunol 2021;12:651715.
- 25. Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med 2020;46:1089-98.
- 26. Moll M, Zon RL, Sylvester KW, Chen EC, Cheng V, Connell NT, et al. VTE in ICU Patients With COVID-19. Chest 2020;158:2130-5.
- 27. Gautret P, Hoang VT, Lagier JC, Raoult D. Effect of hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, an update with an intention-to-treat analysis and clinical outcomes. Int J Antimicrob Agents 2021;57:106239.
- 28. Omma A, Erden A, Apaydin H, Aslan M, Çamlı H, Şahiner ES, et al. Hydroxychloroquine shortened hospital stay and reduced intensive care unit admissions in hospitalized COVID-19 patients. The Journal of Infection in Developing Countries 2021.
- 29. Tang W, Cao Z, Han M, Wang Z, Chen J, Sun W, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ 2020;369:m1849.
There are 29 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Rheumatology and Arthritis |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | July 1, 2024 |
| Submission Date | August 17, 2023 |
| Published in Issue | Year 2024 |