Abstract
Introduction: The SARS-CoV-2 global pandemic has resulted in a universal search for potential treatments of Coronavirus Disease 2019 (COVID-19). Initial reports of the therapeutic potential of chloroquine (CQ) and hydroxychloroquine (HCQ) and early non-randomized non-controlled studies were followed by subsequent trials refuting such properties. The use of CQ and HCQ in diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), prompted us to examine the prevalence of COVID-19 and proposed prophylactic and therapeutic properties of HCQ in this population. Methods: A total of 103 patients with RA and SLE aged 18 to 75 diagnosed with COVID-19 were identified. The patients were categorized as those taking HCQ (cases) and those not on HCQ (controls) for at least 6 months. Primary (mechanical ventilation, length of stay, death) and secondary outcomes were defined, data were collected, and results were compared and statistically analyzed between cases and controls. Results: No statistical difference was observed in demographic features, baseline comorbidities, and medications. Primary outcomes’ statistical analysis did not reveal any differences between cases and controls. Statistical analysis of secondary outcomes revealed that cases had a statistically higher chance of being tachypneic (p 0.034). D-Dimer (p 0.017) and LDH levels (p 0.044) were found to be significantly lower in cases versus controls. Conclusion: This study highlights the lack of clinical prophylactic and therapeutic efficacy of HCQ against COVID-19 when taken at regular doses for patients with RA and SLE. It also shows that the prevalence of COVID-19 was similar in RA and SLE patients regardless of baseline consumption of HCQ.
Highlights
The SARS-CoV-2 global pandemic has resulted in a universal search for potential treatments of Coronavirus Disease 2019 (COVID-19)
The immunomodulatory effects of these medications have been further elucidated through a variety of studies, with these medications shown to inhibit endosomal maturation by abrogating endosomal acidification resulting in inhibition of proteolysis, glycosylation, antigen presentation, and innate and adaptive immune mechanisms by the inhibition of Toll-like receptor signaling, modulation of the production of inflammatory cytokines, Interleukin-1 (IL-1), Interleukin-6 (IL-6), and Tumor Necrosis Factor-alpha (TNF-alpha) by macrophages/monocytes, and inhibition of T- and B-cell signaling [3 - 5]
While the potential prophylactic and therapeutic properties of CQ and HCQ were originally touted by several studies during the early months of the COVID-19 pandemic, subsequent studies including randomized clinical trials and meta-analyses failed to prove such therapeutic potential
Summary
The SARS-CoV-2 global pandemic has resulted in a universal search for potential treatments of Coronavirus Disease 2019 (COVID-19). HCQ inhibition of ACE2 glycosylation is associated with reduced infection in in vitro models and was found to be effective in treating infection and in preventing infection, highlighting the potential prophylactic use of chloroquine and HCQ in SARS-CoV-1 [10] and subsequently SARS-CoV-2 [11 - 13] Influenced by this data and the global search of treatment for COVID-19, Gautret and colleagues reported a nonrandomized clinical trial that demonstrated increased SARSCoV-2 clearance with HCQ [14]. Several follow-up studies by the same group as well as others reported clinical benefit [14, 15], while separate studies found no significant benefit with HCQ in COVID-19 [16 - 22]
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