COVID-19 Resource Center
COVID-19 Resource Center
Perspective from Robin K. Dore, MD
Source/Disclosures
Disclosures: Konig reports personal fees from Bristol-Myers Squibb and Celltrion. Please see the full study for all other authors' relevant financial disclosures.
June 15, 2020
2 min read
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Hydroxychloroquine fails to prevent COVID-19 in patients with lupus

Perspective from Robin K. Dore, MD
Source/Disclosures
Disclosures: Konig reports personal fees from Bristol-Myers Squibb and Celltrion. Please see the full study for all other authors' relevant financial disclosures.
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Patients with systemic lupus erythematosus who received hydroxychloroquine were just as likely to develop severe COVID-19 as those who were not treated with antimalarials, according to data from the COVID-19 Global Rheumatology Alliance registry.

“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,” Maximilian F. Konig, MD, of the Johns Hopkins University School of Medicine, and colleagues wrote in a letter published in Annals of the Rheumatic Diseases. “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 (>400mg daily) and in combination with other QT interval prolonging drugs.”

Patients SLE who received hydroxychloroquine were just as likely to develop severe COVID-19 as those who were not treated with antimalarials, according to data. Source: Adobe Stock

“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,” they added. “This assumption has been challenged by Monti and Montecucco, referencing data from the COVID-19 Global Rheumatology Alliance registry on patients with rheumatic disease that previously identified 19/110 (17%) patients with SLE.”

To analyze antimalarials as prophylaxis for COVID-19, Konig and colleagues analyzed data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Using the data available as of April 17, the researchers identified 80 patients with SLE and COVID-19.

Maximilian F. Konig

Among these patients, 90% were women and 86% were younger than 65 years. Further, 64% of patients with SLE were receiving either hydroxychloroquine or chloroquine — 30% as monotherapy — prior to developing COVID-19.

According to the researchers, treatment with antimalarials had no impact on whether patients with SLE required the maximum level of care related to COVID-19, including noninvasive and invasive ventilation or extracorporeal membrane oxygenation.

The researchers also noted that, at the time of their analysis, 21.1% of the 573 total reported patients with rheumatic disease in the registry were treated with an antimalarial prior to COVID-19 onset. Despite this, 49.6% still required hospitalization.

“In patients with lupus, escalation to maximum level of care (non-invasive ventilation, invasive ventilation or extracorporeal membrane oxygenation [ECMO]) was required regardless of HCQ use,” Konig and colleagues wrote. “Thus, patients with lupus — even if they are using an antimalarial such as HCQ as baseline therapy — can develop SARS-CoV-2 infection and severe COVID-19 at similar frequency as lupus patients not on antimalarials.”