Systematic analysis of COVID-19 infection and symptoms in a systemic lupus erythematosus population: correlation with disease characteristics, hydroxychloroquine use and immunosuppressive treatments

Gendebien et al., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-218244, Jun 2020
Case 4% improvement lower risk ← → higher risk HCQ for COVID-19  Gendebien et al.  PROPHYLAXIS Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 225 patients in Belgium Study underpowered to detect differences c19early.org Gendebien et al., Annals of the Rheuma.., Jun 2020 0 0.5 1 1.5 2+ RR
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 424 studies, used in 59 countries.
Lower risk for mortality, hospitalization, progression, recovery, cases, and viral clearance.
No treatment is 100% effective. Protocols combine treatments.
6,200+ studies for 200+ treatments. c19early.org
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Small study of SLE patients taking HCQ with a phone survey for COVID-19 suggestive symptoms. There was 2 hospitalizations (group not identified) and no ICU or death cases. A similar percentage of suspected infections were reported for HCQ users and non-HCQ users, RR 0.96, p = 0.93.
There was no mortality and severity was not analyzed to determine if HCQ treated patients fared better. No adjustment for concomitant medications or severity of SLE. Only 5 cases were PCR confirmed.
This study is excluded in the after exclusion results of meta analysis: not fully adjusting for the baseline risk differences within systemic autoimmune patients.
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risk of case, 3.9% lower, RR 0.96, p = 0.93, treatment 12 of 152 (7.9%), control 6 of 73 (8.2%), NNT 308.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Gendebien et al., 25 Jun 2020, retrospective, Belgium, peer-reviewed, survey, 9 authors.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2025 Belgium United Kingdom Russia USA Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia Mongolia Israel Trinidad and Tobago Hong Kong North Macedonia Belarus Qatar Panama Serbia CAR Belgium favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2025 Belgium United Kingdom Russia USA Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore New Zealand Malawi Czechia Mongolia Israel Trinidad and Tobago North Macedonia Belarus Qatar Panama Serbia Syria Belgium favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Systematic analysis of COVID-19 infection and symptoms in a systemic lupus erythematosus population: correlation with disease characteristics, hydroxychloroquine use and immunosuppressive treatments
Zoé Gendebien, Christian Von Frenckell, Clio Ribbens, Béatrice André, Marie Thys, Marjorie Gangolf, Laurence Seidel, Michel G Malaise, Dr Olivier Malaise
Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-218244
We read with interest the article of Bozzalla Cassione et al about COVID-19 incidence in their systemic lupus erythematosus (SLE) cohort. 1 Their study adds useful epidemiological information about COVID-19 risk in SLE. 1 They suggest that hydroxycholoroquine was not protective, but could not draw definite conclusion and open the question to immunosuppressive drugs' influence. We would like to share analysis of our SLE cohort (n=225) that can help to answer these questions and determine COVID-19 infection risk factors. Determining COVID-19 incidence is challenging: PCR lacks sensitivity, was usually realised only in severely ill patients and patients with suggestive benign symptoms could stay at home without medical contact. We studied the incidence of COVID-19 infection, either asserted or suspected, by analysing positive nasopharyngeal PCR, hospitalisation or contact with emergency department, but also suspected diagnosis in ambulatory medicine. Each patient was called by phone to determine COVID-19 suggestive symptoms since 4 February 2020, date of the first case in our country. Among our patients, 92.9% were female, with a mean (±SD) age of 51.7 (±14.9) years. Most recent biological evaluation showed positivity for ds-DNA in 24% (median (min-max) levels: 139 (12-758) IU/mL). Mean (±SD) number of 1997 American College of Rheumatology (ACR), 2019 American College of Rheumatology/European League Against Rheumatism (ACR/ EULAR) and Systemic Lupus International Collaborating Clinics (SLICC) classification criteria were 4.5 (±1.5), 20.0 (±8.1) and 5.8 (±2.2), respectively. One hundred and fifty-two (68.1%) patients received chronic treatment with hydroxychloroquine,
References
Bozzalla Cassione, Zanframundo, Biglia, COVID-19 infection in a northern-Italian cohort of systemic lupus erythematosus assessed by telemedicine, Ann Rheum Dis, doi:10.1136/annrheumdis-2020-217717
Gartshteyn, Askanase, Schmidt, COVID-19 and systemic lupus erythematosus: a case series, Lancet Rheumatol, doi:10.1016/S2665-9913(20)30161-2
Gianfrancesco, Hyrich, Al-Adely, Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 global rheumatology alliance physician-reported registry, Ann Rheum Dis, doi:10.1136/annrheumdis-2020-217871
Haberman, Axelrad, Chen, Covid-19 in Immune-Mediated Inflammatory Diseases -Case Series from New York, N Engl J Med, doi:10.1056/NEJMc2009567
Mathian, Mahevas, Rohmer, Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under longterm treatment with hydroxychloroquine, Ann Rheum Dis, doi:10.1136/annrheumdis-2020-217566
Xu, Chen, Yuan, Factors associated with prolonged viral RNA shedding in patients with COVID-19, Clinical Infectious Diseases
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