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  • Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19

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Letter
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

https://doi.org/10.1136/annrheumdis-2020-217690

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    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 …

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    Footnotes

    • Handling editor Josef S Smolen

    • Twitter @MaxKonigMD, @alhkim, @IDPharmacometrx, @pedrommcmachado, @philipcrobinson

    • Collaborators COVID-19 Global Rheumatology Alliance (full list of collaborators at: https://rheum-covid.org/about/)

    • Contributors MFK, DL and PCR conceptualised the article and drafted the manuscript. MG did the data analyses. All authors contributed to data interpretation, writing and final approval of the manuscript.

    • Funding MFK was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health (NIH) under Award no. T32AR048522 and received personal fees from Bristol-Myers Squibb and Celltrion, unrelated to this manuscript. AHK was supported by grants from NIH/NIAMS and Rheumatology Research Foundation and personal fees from Exagen Diagnostics, Inc and GlaxoSmithKline, unrelated to this manuscript. PMM is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre and received consulting or speaker’s fees from Abbvie, Eli Lilly, Novartis and UCB Pharma. JY received personal fees from Astra Zeneca and Eli Lilly, unrelated to this manuscript. PCR reports personal fees from Abbvie, Pfizer, UCB Pharma, Novartis, Eli Lilly and Janssen and non-financial support from Roche.

    • Disclaimer The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance, and do not necessarily represent the views of the American College of Rheumatology, the European League Against Rheumatism, or any other organisation.

    • Competing interests MFK received personal fees from Bristol-Myers Squibb and Celltrion, unrelated to this manuscript. AHK received personal fees from Exagen Diagnostics, Inc and GlaxoSmithKline, unrelated to this manuscript. PMM received personal fees from Abbvie, Eli Lilly, Novartis and UCB Pharma. JY received personal fees from Astra Zeneca and Eli Lilly, unrelated to this manuscript. PCR reports personal fees from Abbvie, Pfizer, UCB Pharma, Novartis, Eli Lilly and Janssen, and non-financial support from Roche.

    • 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.

    • Patient consent for publication Not required.

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