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Comment on ‘Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19’ by Konig et al. Long-term exposure to hydroxychloroquine or chloroquine and the risk of hospitalisation with COVID-19: a nationwide, observational cohort study in 54 873 exposed individuals and 155 689 matched unexposed individuals in France
  1. Emilie Sbidian1,2,
  2. Laetitia Penso1,2,
  3. Philippe Herlemont1,
  4. Jérémie Botton1,
  5. Bérangère Baricault1,
  6. Laura Semenzato1,
  7. Jérome Drouin1,
  8. Alain Weill1,
  9. Rosemay Dray-Spira1,
  10. Mahmoud Zureik1,3
  1. 1 EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France
  2. 2 University Paris-Est Créteil, Research Unit Epidemiology in Dermatology and evaluation of therapeutics, F-94000, Créteil, France
  3. 3 University Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective evasion and pharmacoepidemiology, CESP, F-78180, Montigny le Bretonneux, France
  1. Correspondence to Professor Emilie Sbidian, EPI-PHARE, F-93285, Saint Denis; Université Paris Est, F-94000, Créteil, France; emilie.sbidian{at}

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We have read the recent report by Konig et al 1 with great interest where they described the clinical course of COVID-19 in 80 patients with systemic lupus erythematosus. The frequency of hospitalisation with COVID-19 did not differ between individuals using a synthetic antimalarial drug (AMD) and non-users. The objective of this report was to examine the association of long-term synthetic AMD exposure with hospitalisation with COVID-19 in a larger population in France.

We did a nationwide, retrospective, matched ‘exposed/unexposed’ cohort study using information from the French national health data system (online supplementary methods).2 All individuals who had six reimbursements of synthetic AMD (hydroxychloroquine (HCQ) or chloroquine) within the 12-month period preceding study entry (15 February 2020) were included. For each exposed individual, we randomly selected, from the entire French population, up to three unexposed individuals matched on age, sex, department of residence and complementary universal health insurance. The underlying diseases related to synthetic AMD exposure were recorded, as well as comorbidities and consumption of oral steroids (online supplementary tables 1 and 2). Our study was based on data available on hospital discharges as of 7 June 2020 (online supplementary methods). On this date, 83 445 patients with hospitalisation with COVID-19 have been reported, and 14 566 died in hospitals. The primary end point was the time from study entry to hospitalisation with COVID-19. The secondary end point …

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  • Contributors ES, JB, AW, RD-S and MZ conceived and designed the experiments. LP, PH, BB, LS and JD performed the experiments. ES, LP, PH, BB, JB, AW, RD-S and MZ analysed the data. ES, LP, JB, AW, RD-S and MZ interpreted the results. ES wrote the first draft of the manuscript. All authors contributed to the writing of the manuscript. All authors agreed with the results and conclusions of the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. ES is the guarantor.

  • 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.

  • 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.