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Hydroxychloroquine ineffective for COVID-19 prophylaxis in lupus and rheumatoid arthritis
  1. Mendel E Singer1,
  2. David C Kaelber1,2,
  3. Maria J Antonelli3
  1. 1Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  2. 2Internal Medicine and Pediatrics, The MetroHealth System, Cleveland, Ohio, USA
  3. 3Internal Medicine and Rheumatology, Case Western Reserve University at The MetroHealth System, Cleveland, Ohio, USA
  1. Correspondence to Prof Mendel E Singer, Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; mendel{at}

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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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