Risk of coronavirus disease 2019 hospitalization and mortality in rheumatic patients treated with hydroxychloroquine or other conventional disease-modifying anti-rheumatic drugs in Italy. (15th April 2021)

• Record Type: Journal Article
• Authors: Spila Alegiani, Stefania; Crisafulli, Salvatore; Giorgi Rossi, Paolo; Mancuso, Pamela; Salvarani, Carlo; Atzeni, Fabiola; Gini, Rosa; Kirchmayer, Ursula; Belleudi, Valeria; Kurotschka, Peter Konstantin; Leoni, Olivia; Ludergnani, Monica; Ferroni, Eliana; Baracco, Susanna; Massari, Marco; Trifirò, Gianluca
• Is Part Of: Rheumatology. Volume 60:Number SI(2021)
• Page Start: SI25
• Page End: SI36
• Publication Date: 2021-04-15
• Subjects: hydroxychloroquine -- chloroquine -- anti-rheumatic agents -- COVID-19 -- outpatients; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keab348
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: To ascertain if the use of hydroxychloroquine(HCQ)/cloroquine(CLQ) and other conventional DMARDs (cDMARDs) and rheumatic diseases per se may be associated with COVID-19-related risk of hospitalization and mortality. Methods: This case–control study nested within a cohort of cDMARD users was conducted in the Lombardy, Veneto, Tuscany and Lazio regions and Reggio Emilia province. Claims databases were linked to COVID-19 surveillance registries. The risk of COVID-19-related outcomes was estimated using a multivariate conditional logistic regression analysis comparing HCQ/CLQ vs MTX, vs other cDMARDs and vs non-use of these drugs. The presence of rheumatic diseases vs their absence in a non-nested population was investigated. Results: A total of 1275 patients hospitalized due to COVID-19 were matched to 12 734 controls. Compared with recent use of MTX, no association between HCQ/CLQ monotherapy and COVID-19 hospitalization [odds ratio (OR) 0.83 (95% CI 0.69, 1.00)] or mortality [OR 1.19 (95% CI 0.85, 1.67)] was observed. A lower risk was found when comparing HCQ/CLQ use with the concomitant use of other cDMARDs and glucocorticoids. HCQ/CLQ was not associated with COVID-19 hospitalization as compared with non-use. An increased risk for recent use of either MTX monotherapy [OR 1.19 (95% CI 1.05, 1.34)] or other cDMARDs [OR 1.21 (95% CI 1.08, 1.36)] vs non-use was found. Rheumatic diseases were not associated with COVID-19-related outcomes. Conclusion: HCQ/CLQ use in rheumatic patients was not associated with a protective effect against COVID-19-related outcomes. The use of other cDMARDs was associated with an increased risk when compared with non-use and, if concomitantly used with glucocorticoids, also vs HCQ/CLQ, probably due to immunosuppressive action.