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Hydroxychloroquine ineffective for COVID-19 prophylaxis in lupus and rheumatoid arthritis
  1. Mendel E Singer1,
  2. David C Kaelber1,2,
  3. Maria J Antonelli3
  1. 1 Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  2. 2 Internal Medicine and Pediatrics, The MetroHealth System, Cleveland, Ohio, USA
  3. 3 Internal Medicine and Rheumatology, Case Western Reserve University at The MetroHealth System, Cleveland, Ohio, USA
  1. Correspondence to Prof Mendel E Singer, Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; mendel{at}case.edu

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The viewpoint of Graef et al resonates more each day.1 In a pandemic where the cries for certainty were met with a flow of mixed early study results, they admonish festina lente (‘make haste slowly’)! Since Graef, there have been many studies of hydroxychloroquine (HCQ) for treating COVID-19. These include a randomised controlled trial of 150 mild-to-moderate patients and three large observational studies, all inpatient studies that failed to show benefit of HCQ treatment for COVID-19.2–5 Now a new inpatient study, with >80% administered HCQ within 24 hours, finds HCQ associated with substantial mortality reduction.6 Festina lente indeed! A look at HCQ as prophylaxis, where its long half-life can be leveraged, may help.7

Bozzalla Cassione and colleagues described a northern Italian cohort of 165 patients with systemic lupus erythematosus (SLE).8 HCQ users had 50% greater risk of COVID-19 (7.9% vs 5.3%; 95% CI for the difference −9.9% to 9.7%), but were limited by just 12 patients with COVID-19 and possible bias due to concomitant immunosuppressive therapy. A Belgian study of 225 patients with SLE found 7.9% of HCQ users and 8.2% of non-HCQ users had COVID-19 (95% CI for the difference −6.7% to 9.5%), and another Italian …

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Footnotes

  • Correction notice This article has been corrected since it published Online First. A typographical error in the title has been corrected.

  • Contributors MES designed the study, made the statistical analysis and drafted the manuscript. DCK provided access to the data. DCK and MJA assisted in the design and revised the manuscript.

  • 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, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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