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As obstetricians with a maternal–foetal medicine practice taking care of pregnant women treated with hydroxychloroquine (HCQ) in the prevention of systemic lupus erythematosus (SLE) flare, we read with interest the recent report of clinical data collected through the COVID-19 Global Rheumatology Alliance registry.1 Indeed, in the current epidemic, a number of cases of severe acute respiratory syndrome have occurred worldwide in pregnant women and have jeopardised both mother and fetus and have sometimes led to extreme prematurity, confirming reports from previous coronavirus outbreaks.2 Hence, any safe treatment with a potential for prevention of severe forms of COVID-19 would be of great interest. As HCQ used in the prevention of SLE flare has a good safety profile during pregnancy, and its continuation is even recommended in pregnant patients with SLE by the American College of Obstetricians and Gynaecologists,3 this drug could be a good candidate.
From the global physician-reported registry, Konig et al 1 identified 80 patients with SLE and COVID-19 and concluded that patients with SLE on baseline therapy with HCQ are not universally protected from COVID-19. The authors report that patients were predominantly female and less than 65 years of age, with a similar proportion of severe forms whether or not they were treated ‘with an antimalarial prior to onset of COVID-19’. However, no information was given about comorbidities that could explain progression of the disease in each group.
Indeed, the authors refer to another recent report by Mathian et al,4 who also tackle this issue of the possible protective effect of HCQ against COVID-19 in such context. However, in this series of 17 patients, Mathian et al 4 report an important proportion of major comorbidities as compared with recent large-scale studies assessing the prognosis in SLE populations of patients5: obesity and chronic kidney disease are present in 10 (59%) and 8 patients (48%), hypertension in 6 (35%), venous thrombosis in 4 (24%), arterial thrombosis in 3 (18%), cerebrovascular disease in 3 (18%), coronary heart disease or cardiovascular disease in 2 (12%), chronic obstructive lung disease in 2 (12%) and malignant tumour in 1 (6%).
In addition, in this short series,4 two patients (12%) were administered prednisone greater than or equal to 10 mg/day, and 7 (41%) had an immunosuppressant treatment, which raises other questions regarding the effect of these drugs on the course of COVID-19; also, the proportion of patients with anticoagulant treatment was only 29%, whereas a history of thrombosis existed in 35% of cases, and the involvement of thromboses in the progression of COVID-19 is now well documented.6
As all these factors and comorbidities may have an important impact on the progression of COVID-19 and must be taken into account, it is difficult for us to really consider from such data that HCQ has no protective effect.
Contributors LC, AB and JB contributed to the critical analysis of the articles. LC wrote the main document.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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