HIBISCUS: Hydroxychloroquine for the secondary prevention of thrombotic and obstetrical events in primary antiphospholipid syndrome
C. BeliznaFrancesca PregnolatoS. AbadJaume Alijotas‐ReigHoward AmitalZahir AmouraLaura AndréoliEmmanuel AndrèsAchile AoubaŞule Apraş BilgenLaurent ArnaudBoris BienvenuViktoria BitsadzePatrick BlancoMiri BlankMaría Orietta BorghiAntonia CaligaroElisabeta CandreaValentina CantiLaurent ChicheJ ChrétienJan Willem Cohen TervaertLaura DamianTeresa DelrossEmmanuelle DernisKatrien DevreeseAleksandra DjokovićEnrique Esteve‐ValverdeMaria FavaròCéline FassotRaquel Ferrer‐OliverasAlban GodonM. HamidouMilena HasanDaniel HenrionB. ImbertP JeandelPascale JeanninP. JégoNoémie Jourde‐ChicheJ. Kh. KhizroevaOlivier LambotteC. LandronJosé Omar LatinoEstibaliz LazaroKarina de LeeuwThomas Le GallouLevent KılıçMaarten LimperLaurent LoufraniRomain LubinN. Magy‐BertrandGuillaume MahéА. D. MakatsariyaThierry MartinChristian MuchardtGyörgy NagyLoukman OmarjeePieter Van PaasenGilles PernodFlorence PerrinetGilberto Pires da RosaMarc Antoine PistoriusAmelia RuffattiFatma SaidPatrick SaulnierD. SèneLoı̈c SentilhesOva ShovmanJean SibiliaCrina SinescuNataša StanisavljevićLjudmila StojanovichLai‐Shan TamAnǵela TincaniFréderic TollisSebastián UdryMarie Noëlle UngeheuerMathilde VersiniRicard CerveraPier Luigi Meroni
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Hydroxychloroquine
Background: Hydroxychloroquine is currently being tested as post-exposure prophylaxis against coronavirus disease 2019 (COVID-19) in several ongoing clinical trials. Objective: To compare the incidence of COVID-19 in Spanish patients with autoimmune rheumatic diseases treated with and without hydroxychloroquine. Methods: Retrospective electronic record review, from February 27th to April 16th, of patients with autoimmune inflammatory diseases followed at two academic tertiary care hospitals in Seville, Spain. The cumulative incidence of COVID-19, confirmed or suspected, was compared between patients with and without hydroxychloroquine as part of their treatment of autoimmune inflammatory diseases. Results: Among 722 included subjects, 290 (40%) were receiving hydroxychloroquine. During the seven-week study period, five (1.7% [95% CI: 0.5%-4.0%] cases of COVID-19 were registered among patients with hydroxychloroquine and five (1.2% [0.4%-2.7%]) (p=0.523) in without hydroxychloroquine. COVID-19 was confirmed by PCR in one (0.3%, 95% CI 0.008-1.9%) patient with hydroxychloroquine and two (0.5%, 95% CI 0.05%-1.6%) without hydroxychloroquine (p=1.0). One patient on hydroxychloroquine and two subjects without hydroxychloroquine were admitted to the hospital, none of them required to be transferred to the intensive care unit and no patient died during the episode. Conclusions: The incidence and severity of COVID-19 among patients with autoimmune rheumatic diseases with and without hydroxychloroquine was not significantly different. Hydroxychloroquine does not seem to be an appropriate therapy for post-exposure prophylaxis against COVID-19.
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Told from the viewpoint of rheumatologists, this review tells the story of hydroxychloroquine and its swift ascent to become a household name as a therapeutic strategy against the novel SARS-CoV-2 virus. This review describes the history, mechanisms, pharmacokinetics, therapeutic applications, and safety profile of hydroxychloroquine as an immunomodulatory and antiviral agent. It also summarizes the major studies that launched and assessed the use of hydroxychloroquine against COVID-19 infection. More recent literature calls into question the long-held dogma that endolysosomal alkalinization is the primary mode of action of hydroxychloroquine. Ongoing uncertainty about the multiple potential mechanisms contributing to the therapeutic effect of hydroxychloroquine in rheumatic and viral disease led to a natural avenue for exploration in the treatment of COVID-19. Taken as a whole, the literature does not support utilizing hydroxychloroquine to treat or prevent infection from the SARS-CoV-2 virus. This is, at least in part, due to the wide variability in hydroxychloroquine pharmacokinetics between patients and difficulty achieving adequate target tissue concentrations of hydroxychloroquine without encountering unacceptable toxicities. Hydroxychloroquine continues to be a routinely prescribed, well-tolerated, effective, and low-cost treatment for rheumatic disease. Its therapeutic versatility has led to frequent repurposing for other conditions, most recently as an investigative treatment against the SARS-CoV-2 virus. Despite overall negative findings, the intense study of hydroxychloroquine against COVID-19 infection has enhanced our overall understanding of how hydroxychloroquine operates in autoimmune disease and beyond.
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Antiphospholipid syndrome (APS) is an autoimmune disease characterised by arterial and venous thrombosis. Recurrent thrombosis and pregnancy losses are important in its diagnosis. Due to the risk of recurrence of thrombosis, long-term anticoagulant treatment may be required. Here, we present the case of a patient who suffered from intracardiac thrombosis due to APS. At present, treatment for significant thrombotic events in patients with APS, such as the aforementioned intracardiac thrombosis, is generally lifelong.
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Background Hydroxychloroquine is not efficacious as post-exposure prophylaxis against coronavirus disease 2019 (COVID-19). It is not known whether as pre-exposure prophylaxis it may prevent COVID-19. Objective To compare the incidence of COVID-19 in Spanish patients with autoimmune rheumatic diseases treated with and without hydroxychloroquine. Patients and methods Retrospective electronic record review, from February 27 th to June 21 st , 2020, of patients with autoimmune inflammatory diseases followed at two academic tertiary care hospitals in Seville, Spain. The cumulative incidence of confirmed COVID-19, by PCR or serology, was compared between patients with and without hydroxychloroquine as part of their treatment of autoimmune inflammatory diseases. Results Among 722 included patients, 290 (40%) were receiving hydroxychloroquine. During the seventeen-week study period, 10 (3.4% [95% CI: 1.7%-6.7%] cases of COVID-19 were registered among patients with hydroxychloroquine and 13 (3.0% [1.6%-5.1%]) (p = 0.565) in those without hydroxychloroquine. COVID-19 was diagnosed by PCR in four (1.4%, 95% CI 0.38%-3.5%) subject with hydroxychloroquine and six (1.4%, 95% CI 0.5%-3.0%) without hydroxychloroquine (p = 0.697). Three patients on hydroxychloroquine and four patients without hydroxychloroquine were admitted to the hospital, none of them required to be transferred to the intensive care unit and no patient died during the episode. Conclusions The incidence and severity of COVID-19 among patients with autoimmune rheumatic diseases with and without hydroxychloroquine was not significantly different.
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Abstract INTRODUCTION: The effectiveness of hydroxychloroquine in SARS-CoV-2 prophylaxis and treatment is still controversial. In this study, our aim is to investigate the potential effects of hydroxychloroquine therapy on patients with diagnosed with rheumatoid arthritis and a confirmed SARS-CoV-2 infection.METHOD: We included patients who were followed up with a diagnosis of rheumatoid arthritis and whose SARS-CoV-2 infection was confirmed. The patients were divided into two groups as those who previously used hydroxychloroquine and those who did not, and were compared in terms of clinical and laboratory data.RESULTS: Our study included 17 patients with adequate data (2 males, 15 females). The mean age of the patients was 57.2 ± 11.6 years. 7 (41.2%) patients were receiving hydroxychloroquine regularly for the last 6 months. When the effect of hydroxychloroquine on clinical and laboratory parameters of patients was examined, there was no significant difference between the groups of patients using and not using hydroxychloroquine. The patients using and not using hydroxychloroquine were compared for the presence of typical SARS-CoV-2 infection findings on computed tomography images, admission to the hospital and intensive care. No significant differences were observed between these two groups.CONCLUSIONS: Many studies on the effectiveness of hydroxychloroquine use in SARS-CoV-2 infection are still ongoing. Due to its importance in rheumatology practice, it is very important to clarify the position of hydroxychloroquine in SARS-CoV-2 therapy. Our findings suggest that having previously used hydroxychloroquine does not have any negative or positive effect on the infection.
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