Article Text

Download PDFPDF

Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19
  1. Maximilian F Konig1,
  2. Alfred HJ Kim2,3,4,
  3. Marc H Scheetz5,6,
  4. Elizabeth R Graef7,
  5. Jean W Liew8,
  6. Julia Simard9,
  7. Pedro M Machado10,11,12,
  8. Milena Gianfrancesco13,
  9. Jinoos Yazdany13,
  10. Daman Langguth14,
  11. Philip C Robinson15
  12. On behalf of the COVID-19 Global Rheumatology Alliance
  1. 1 Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
  3. 3 Division of Immunobiology, Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
  4. 4 Andrew M. and Jane M. Bursky Center of Human Immunology and Immunotherapy Programs, Washington University School of Medicine, Saint Louis, Missouri, USA
  5. 5 Departments of Pharmacy Practice and Pharmacology; Pharmacometrics Center of Excellence, Midwestern University, Chicago College of Pharmacy, and College of Graduate Studies, Downers Grove, Illinois, USA
  6. 6 Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
  7. 7 Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  8. 8 Division of Rheumatology, Department of Medicine, University of Washington, Seattle, Washington, USA
  9. 9 Department of Epidemiology & Population Health; Department of Medicine, Division of Immunology & Rheumatology, Stanford University School of Medicine, Stanford, California, USA
  10. 10 Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
  11. 11 Department of Rheumatology & Queen Square Centre for Neuromuscular Diseases, University College London Hospitals NHS Foundation Trust, London, UK
  12. 12 Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
  13. 13 Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
  14. 14 Department of Immunology, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
  15. 15 The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
  1. Correspondence to Dr Maximilian F Konig, Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; konig{at}jhmi.edu; Dr Philip C Robinson, The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia; philip.robinson{at}uq.edu.au

Statistics from Altmetric.com

The use of hydroxychloroquine (HCQ) in the prophylaxis and treatment of coronavirus disease 2019 (COVID-19) has received significant attention by politicians and media figures. This has occurred despite limited data supporting its efficacy in COVID-19 as well as considerable concern about its safety when used at high doses (>400 mg daily) and in combination with other QT interval prolonging drugs.1–4

An inaccurate narrative has emerged in recent weeks that patients with systemic lupus erythematosus (SLE) who are taking HCQ as a baseline therapy are less affected by or do not develop COVID-19.5–7 This assumption has been challenged by Monti and Montecucco,8 referencing data from the COVID-19 Global Rheumatology Alliance registry on patients with rheumatic disease that previously identified 19/110 (17%) patients with SLE.9 A case series of 17 patients with lupus or antiphospholipid syndrome who developed COVID-19 on a median HCQ dose of 400 mg daily (median HCQ blood level of 648 ng/mL) has since become available.10 As of 17 April 2020, we have now identified 80 patients with SLE and COVID-19 in the global physician-reported registry. Patients were predominantly female (72/80, 90%) and less than 65 years of age (69/80, 86%). Importantly, 64% (51/80) of patients with SLE were taking an antimalarial (HCQ or chloroquine) prior to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (30% as monotherapy). Notably, 21.1% (121/573) of all reported patients with rheumatic disease in the registry were treated with an antimalarial prior to onset of COVID-19, yet 49.6% (60/121) required hospitalisation. In patients with SLE, frequency of hospitalisation with COVID-19 …

View Full Text

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.