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23-11-2020 | COVID-19 | News

No reduction in COVID-19 mortality risk with routine hydroxychloroquine use in RMD patients

Claire Barnard

medwireNews: Use of hydroxychloroquine for the treatment of rheumatic and musculoskeletal diseases (RMDs) is not associated with a reduction in COVID-19 mortality risk, suggest findings from an observational study published in The Lancet Rheumatology.

These results “do not provide any strong support for a major protective effect from ongoing routine hydroxychloroquine use, as has been previously hypothesised,” and “[t]he use of hydroxychloroquine for prevention of COVID-19 mortality outside trial settings is currently not justified,” say Christopher Rentsch (London School of Hygiene & Tropical Medicine, UK) and co-investigators.

The researchers used the OpenSAFELY platform to evaluate COVID-19 mortality rates among 194,637 people with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) in the UK, of whom 15.7% received at least two prescriptions of hydroxychloroquine between September 2019 and March 2020.

In all, there were 547 COVID-19 deaths between March and July 2020, including 70 in people taking hydroxychloroquine. Standardized cumulative mortality rates were 0.23% among hydroxychloroquine users and 0.22% among nonusers, with no significant between-group difference after adjustment for age, sex, ethnicity, geographic region, and use of other immunosuppressive drugs.

Rentsch and team note that these findings remained consistent when the 167,874 patients with RA and the 26,763 with SLE were analyzed separately.

Writing in an accompanying comment, April Jorge (Massachusetts General Hospital and Harvard Medical School, Boston, USA) says that “[t]hese findings are not surprising given the mounting body of literature suggesting no clinical benefit for hydroxychloroquine use against COVID-19.”

“However, this study is important in addressing the potential role, or lack thereof, for hydroxychloroquine as a preventive medication for this novel infectious disease,” she adds.

Jorge stresses that “[f]or rheumatologists and our patients, hydroxychloroquine maintains its important, longstanding role in the treatment of rheumatic diseases, with known benefits ranging from reducing lupus disease activity and damage to lowering the risks of hyperglycaemia, hyperlipidaemia, and pregnancy complications.”

She continues: “However, available evidence does not support the use of this medication in the prevention or treatment of COVID-19.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group

23 November 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Lancet Rheumatol 2020; doi:10.1016/S2665-9913(20)30378-7
Lancet Rheumatol 2020; doi:10.1016/S2665-9913(20)30390-8