Lupus patients see no benefit from HCQ on COVID-19 outcomes

Long-term use of hydroxychloroquine (HCQ) in patients with SLE does not seem to prevent severe COVID-19, according to a small observational study from France.

In a series of 17 patients with long-term SLE and confirmed SARS-CoV-2 infection, the median duration of HCQ use was 7.5 years.

Yet despite the hype about HCQ as a wonder drug in COVID-19, 11 (82%) of the lupus patients were admitted to hospital and 7 (41%) to ICU.

On admission, immunosuppressive medications were interrupted or decreased while HCQ and prednisone were maintained. The median whole blood HCQ concentration in the group was in the therapeutic range at 648 ng/mL.

As reported in Annals of Rheumatic Disease, complications due to respiratory failure occurred in 13 patients and acute respiratory distress syndrome (ARDS) in five patients.

Three patients suffered from acute renal failure, with two patients requiring haemodialysis.

“Oxygen therapy was given to 11 (65%) patients, requiring nasal cannula in 5, high-flow nasal cannula in 1 and invasive mechanical ventilation in 5. One patient was treated with extracorporeal membrane oxygenation,” the authors said.

“As of 7 April, five (36%) patients have been discharged from the hospital, seven (50%) remained hospitalised and two (14%) died.”

They noted that only one of the patients showed clinical signs of lupus – active tenosynovitis in this case – during their COVID-19 disease.

“This case series does not allow to draw conclusions on the incidence rate and severity of COVID-19 in SLE. However, it gives a first clinical picture of the course of this infection in patients with SLE treated with HCQ, and it furthermore paves the way for a larger observational study to identify the risk factors associated with the occurrence of a severe form of COVID-19 in patients with SLE.”

The European DisCoVeRy trial of treatment for COVID19 in hospitalised adults would add more evidence on the efficacy of HCQ and other therapies, they added.

Meanwhile the AustralaSian COVID-19 Trial (ASCOT) is also underway investigating HCQ and lopinavir/ritonavir, either alone or in combination, compared to standard care in hospitalised but not ICU patients.

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