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Response to: ‘Hydroxychloroquine ineffective for COVID-19 prophylaxis in lupus and rheumatoid arthritis’ by Singer et al
  1. Manuel Francisco Ugarte-Gil1,
  2. Maximilian F Konig2,
  3. Peter Korsten3,
  4. Francis Berenbaum4,
  5. Alfred Hyoungju Kim5,
  6. Jeffrey A Sparks6
  1. 1 Department of Rheumatology, Universidad Cientifica del Sur, Lima, Peru
  2. 2 Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3 Department of Nephrology and Rheumatology, University Medical Center Göttingen, Gottingen, Germany
  4. 4 Rheumatology, Sorbonne Université, Paris, France
  5. 5 Medicine/Rheumatology, Washington University in Saint Louis School of Medicine, St. Louis, Missouri, USA
  6. 6 Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Jeffrey A Sparks, 1Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA; jsparks{at}; Dr Alfred Hyoungju Kim; akim{at}

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We thank Singer et al for their correspondence1 about our article related to hydroxychloroquine (HCQ) use, COVID-19 and rheumatology.2 The authors present an interesting analysis using electronic health records from 36 US healthcare organisations, including patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). They found no association of HCQ use versus non-use with COVID-19, influenza/pneumonia/other lower respiratory infections and any outpatient visit, suggesting that baseline use of antimalarials such as HCQ does not prevent COVID-19.

These results suggesting no prophylactic benefit for antimalarials complement findings from the physician-based registry of the COVID-19 Global Rheumatology Alliance (GRA). Among 80 patients with SLE and COVID-19 in the GRA registry, the rates of hospitalisation and requirement of supplemental oxygen were similar in those who were using antimalarials prior to the onset of COVID-19 and those who were not.3 In the entire registry, which included 600 patients with systemic rheumatic disease (RMD) at that time, antimalarials were not associated with lower odds of hospitalisation after adjustment for …

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  • AHK and JAS are joint senior authors.

  • Handling editor Josef S Smolen

  • Twitter @mugartegil, @MaxKonigMD, @pekor002, @larhumato, @alhkim, @jeffsparks

  • AHK and JAS contributed equally.

  • Contributors MFU-G, MFK, PK, FB, AHK and JAS contributed to the conception and drafting of the article. All listed authors provided critical revision for important intellectual content and final approval.

  • 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 PK reports personal fees from GlaxoSmithKline, Sanofi-Aventis, Pfizer, Abbvie, Novartis Pharma, Eli Lilly and Bristol-Myers Squibb. FB reports personal fees from Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Merck Sereno, MSD, Nordic, Novartis, Pfizer, Regulaxis, Roche, Sandoz, Sanofi, Servier, UCB, Peptinov, TRB Chemedica and 4P Pharma. AHK reports grants from National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and Rheumatology Research Foundation and personal fees from Exagen Diagnostics, Inc. and GlaxoSmithKline. Drs Liew and Graef have disclosed no conflicts of interest or competing interests. JAS reports grants from NIH/NIAMS/National Institute of Allergy and Infectious Diseases/Autoimmune Centers of Excellence, the Rheumatology Research Foundation, the Brigham Research Institute, and the R. Bruce and Joan M. Mickey Research Scholar Fund as well as personal fees from Bristol-Myers Squibb, Gilead, Inova, Janssen and Optum.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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