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Can hydroxychloroquine protect patients with rheumatic diseases from COVID-19? Response to: ‘Does hydroxychloroquine prevent the transmission of COVID-19?’ by Heldwein and Calado and ‘SLE, hydroxychloroquine and no SLE patients with COVID-19: a comment’ by Joob and Wiwanitkit
  1. Sara Monti,
  2. Carlomaurizio Montecucco
  1. Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
  1. Correspondence to Dr Sara Monti, Rheumatology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; sara.saramonti{at}

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We thank Dr Heldwein and Calado1 and Dr Joob and Wiwanitkit2 for their interest and comments on our paper.3 The authors raised the hypothesis that chronic use of hydroxychloroquine (HCQ) for the currently approved indications, such as systemic lupus erythematosus (SLE), could have an impact on the rate of COVID-19 and possibly on the clinical course of the infection.

An in vitro antiviral effect of HCQ has been demonstrated on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Evidence suggests that HCQ can interfere with the virus-receptor binding and proliferation, potentially suggesting a prophylactic and therapeutic role of the drug, together with the advantages of its immunomodulatory activity.4 5 Given the urgent need to identify an efficacious treatment to reduce mortality during the COVID-19 pandemic, HCQ has been included in a number of national protocols and guidelines to treat the infection, based on the results of preliminary clinical data. Nevertheless, the evidence supporting the use of HCQ in vivo is still based …

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