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Oxford University Press - PMC COVID-19 Collection logoLink to Oxford University Press - PMC COVID-19 Collection
. 2021 Apr 15:keab348. doi: 10.1093/rheumatology/keab348

Risk of COVID-19 hospitalization and mortality in rheumatic patients treated with hydroxychloroquine or other conventional DMARDs in Italy

Stefania Spila Alegiani 1,1, Salvatore Crisafulli 2,3,1, Paolo Giorgi Rossi 4, Pamela Mancuso 4, Carlo Salvarani 5,6, Fabiola Atzeni 7, Rosa Gini 8, Ursula Kirchmayer 9, Valeria Belleudi 9, Peter Konstantin Kurotschka 10,11, Olivia Leoni 12, Monica Ludergnani 12, Eliana Ferroni 13, Susanna Baracco 13, Marco Massari 1,✉,2, Gianluca Trifirò 3,14,2; ITA-COVID-19 Network
PMCID: PMC8083276  PMID: 33856453

Abstract

Objectives

To ascertain if hydroxychloroquine (HCQ)/chloroquine (CLQ) and other conventional disease-modifying anti-rheumatic drugs (cDMARDs) use, 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. Risk of COVID-19-related outcomes was estimated using a multivariate conditional logistic regression analysis, comparing HCQ/CLQ vs methotrexate, vs other cDMARDs and vs non-use of these drugs. Presence of rheumatic diseases vs their absence in a non-nested population was investigated.

Results

1275 cases hospitalized due to COVID-19 were matched to 12 734 controls. Compared with recent use of methotrexate, no association between HCQ/CLQ monotherapy and COVID-19 hospitalization (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 to 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 methotrexate 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. 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 to be ascribed to immunosuppressive action.

Keywords: Hydroxychloroquine, Chloroquine, Antirheumatic agents, COVID-19, outpatients


Articles from Rheumatology (Oxford, England) are provided here courtesy of Oxford University Press

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