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- lupus erythematosus
- communicable diseases
- outcome assessment
- health care
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 study …
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