Chronic treatment with hydroxychloroquine and SARS‐CoV‐2 infection
MD António Ferreira, António Oliveira‐e‐silva, MD Paulo Bettencourt
Journal of Medical Virology, doi:10.1002/jmv.26286
The first case of SARS-CoV-2 infection in Portugal was recorded on 2 March 2020. Since then, until the moment we analyzed the data, 360 304 patients with suspected SARS-CoV-2 infection had a final case definition (positive PCR test or negative PCR test). In 248 cases the PCR test result was inconclusive and had not yet been repeated at the time of data extraction. Of these 360 304 cases, 26 815 were confirmed by a positive PCR test. The rest had negative PCR tests.
| FERREIRA ET AL.
CONFLICT OF INTERESTS The authors declare that there are no conflict of interests.
References
Boulware, Pullen, Bangdiwala, A randomized trial of hydroxychloroquine as postexposure prophylaxis for COVID-19
Bouza, Moya, Muñoz, Infections in systemic lupus erythematosus and rheumatoid arthritis, Infect Dis Clin North Am
Branco, Canhão, Epidemiological study of rheumatic diseases in Portugal-EpiReumaPt, Acta Reumatol Port
Chatterjee, Anand, Singh, Healthcare workers & SARS-CoV-2 infection in India: a case-control investigation in the time of COVID-19, Indian J Med Res
Chen, Hu, Zhang, Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial, medRxiv,
doi:10.1101/2020.03.22.20040758Choo, Cher, Kwan, Fong, Risk factors for cytomegalovirus disease in systemic lupus erythematosus (SLE): a systematic review, Adv Rheumatol
Costedoat-Chalumeau, Dunogué, Leroux, A critical review of the effects of hydroxychloroquine and chloroquine on the eye, Clin Rev Allergy Immunol
Fanouriakis, Kostopoulou, Alunno, update of the EULAR recommendations for the management of systemic lupus erythematosus, Ann Rheum Dis
Ferreira, None
Gao, Tian, Yang, Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies, Biosci Trends
Gautret, Lagier, Parola, Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label nonrandomized clinical trial, Int J Antimicrob Agents
Geleris, Sun, Platt, Observational study of hydroxychloroquine in hospitalized patients with COVID-19, N Engl J Med,
doi:10.1056/NEJMoa2012410Gendelman, Amital, Bragazzi, Watad, Chodick, Continuous hydroxychloroquine or colchicine therapy does not prevent infection with SARS-CoV-2: insights from a large healthcare database analysis, Autoimmun Rev,
doi:10.1016/j.autrev.2020.102566Haładyj, Sikora, Felis-Giemza, Olesińska, Antimalarials-are they effective and safe in rheumatic diseases?, Reumatologia
Herrinton, Liu, Goldfien, Michaels, Tran, Risk of serious infection for patients with systemic lupus erythematosus starting glucocorticoids with or without antimalarials, J Rheumatol
Iliopoulos, Tsokos, Immunopathogenesis and spectrum of infections in systemic lupus erythematosus, Semin Arthritis Rheum
Kim, Feldman, Moscicki, Risk of human papillomavirus infection in women with rheumatic disease: cervical cancer screening and prevention, Rheumatology
Li, Lai, Wang, Risk of severe herpes simplex virus infection in systemic lupus erythematosus: analysis of epidemiology and risk factors analysis in Taiwan, Ann Rheum Dis
Listing, Gerhold, Zink, The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment, Rheumatology
Liu, Cao, Xu, Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro, Cell Discov
Liu, Li, Zhang, Chloroquine and hydroxychloroquine are associated with reduced cardiovascular risk: a systematic review and meta-analysis, Drug Des Devel Ther
Ruil-Irastorga, Olivares, Ruiz-Arruza, Martinez-Berriotxoa, Egurbide et al., Predictors of major infections in systemic lupus erythematous, Arthritis Res Ther,
doi:10.1186/ar2764Tripathy, Dassarma, Chabalala, Matsabisa, Ferreira et al., A review on possible modes of action of chloroquine/hydroxychloroquine: repurposing against SAR-CoV-2 (COVID-19) pandemic, Int J Antimicrob Agents
Wang, Cao, Zhang, Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res
Yao, Ye, Zhang, In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Clin Infect Dis
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'abstract': '<jats:title>Abstract</jats:title><jats:p>Hydroxychloroquine sulfate (HCQ) is being '
'scrutinized for repositioning in the treatment and prevention of severe acute respiratory '
'syndrome coronavirus 2 (SARS‐CoV‐2) infection. This antimalarial drug is also chronically '
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'treatment (at least 2 grams per month) in laboratory confirmed cases of SARS‐CoV‐2 infection '
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'(0.29%) were chronically treated with HCQ, while 1215 (0.36%) out of 333\u2009489 negative '
'patients were receiving it chronically (<jats:italic>P</jats:italic>\u2009=\u2009.04). After '
'adjustment for age, sex, and chronic treatment with corticosteroids and/or '
'immunosuppressants, the odds ratio of SARS‐CoV‐2 infection for chronic treatment with HCQ has '
'been 0.51 (0.37‐0.70). Our data suggest that chronic treatment with HCQ confer protection '
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