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Correspondence
Correspondence on ‘Festina lente: hydroxychloroquine, COVID-19 and the role of the rheumatologist’ by Graef et al
  1. Chien Hsien Lo1,2,
  2. Yu-Hsun Wang3,
  3. Chin Feng Tsai1,2,
  4. Kuei Chuan Chan1,2,
  5. Li Ching Li4,
  6. Tse Hsien Lo4,
  7. Chun Hung Su1,2,
  8. James Cheng-Chung Wei5,6,7
  1. 1 Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
  2. 2 Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
  3. 3 Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
  4. 4 Department of Internal Medicine, DaChien General Hospital, Miaoli, Taiwan
  5. 5 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
  6. 6 Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
  7. 7 Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
  1. Correspondence to Dr James Cheng-Chung Wei, Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; wei3228{at}gmail.com; Dr Chun Hung Su; such197408{at}gmail.com

https://doi.org/10.1136/annrheumdis-2020-218589

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    We read with interest the study by Graef et al,1 who mentioned about the treatment and safety of hydroxychloroquine (HCQ) for the current COVID-19 pandemic. They described that decades of research strongly support the well control of disease activity and survival benefit of HCQ use in rheumatic diseases, such as systemic lupus erythematosus and rheumatoid arthritis (RA). They also highlight that HCQ should be used with caution in patients with COVID-19, including the safety concern, especially when combined with administration of azithromycin because both of them are known corrected QT interval (QTc) prolongation agents.

    During early outbreak, HCQ, combined with azithromycin, has been used as a treatment option for COVID-19.2 3 Recently, an observational study with 1446 patients with COVID-19 reported that HCQ administration was not associated with a lower risk of intubation or death.4 However, the reasons for mortality were not illustrated. Multiple confounding factors like histories of ischaemic heart disease, heart failure and cardiac arrhythmia were not well adjusted. The main functional site of HCQ in COVID-19 is the entry via ACE2 preceptor.5 6 We believe that patient selection in early phases of COVID-19 infection would be more appropriate than well-established pneumonia or cytokines storm cases.

    The risk of cardiac arrhythmias is an important safety issue. HCQ inhibits the ‘funny’ current of sinoatrial node and rapid component of the delayed rectifier potassium current, causing lengthening of the …

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    Footnotes

    • Contributors CHL designed the study, generated the figures and wrote the manuscript. Y-HW analysed the data and generated figures. CFT, KCC, LCL and THL performed bioinformatics analysis and wrote the manuscript. CHS and JC-CW made substantial contributions to the design of the study, conducted the data analysis and figure generation, and wrote the manuscript. All authors read and approved the final 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, conduct, reporting or dissemination plans of this research.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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