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Incidence and risk factors for moderate/severe COVID-19 in rheumatic diseases patients on hydroxychloroquine: a 24-week prospective cohort


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39

 

  1. Hospital São Paulo da Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp/EPM), São Paulo-SP, Brazil. mpinheiro@uol.com.br
  2. Hospital São Paulo da Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp/EPM), São Paulo-SP, Brazil.
  3. Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte-MG, Brazil.
  4. Hospital Universitário de Brasília da Universidade de Brasília, EBSERH (HUB-UnB), Brasília-DF, Brazil.
  5. Hospital São Paulo da Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp/EPM), São Paulo-SP, Brazil.
  6. Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil.
  7. Hospital Universitário de Brasília da Universidade de Brasília, EBSERH (HUB-UnB), Brasília-DF, Brazil.
  8. Hospital do Servidor Público Estadual, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo-SP, Brazil.
  9. Faculdade de Medicina de Barretos (FACISB), Education & Research Institute Cancer Hospital Barretos, Barretos-SP, Brazil.
  10. Santa Casa de Misericórdia do Rio de Janeiro (HGSCMRJ), Rio de Janeiro-RJ, Brazil.
  11. Hospital São Paulo da Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp/EPM), São Paulo-SP, Brazil.
  12. Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo-SP, Brazil.
  13. Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo-SP, Brazil.
  14. Hospital Universit rio Lauro Wanderley, Universidade Federal da Para ba (UFPB), Jo o Pessoa-PB, Brazil.
  15. Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte-MG, Brazil.
  16. Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE), Recife-PE, Brazil.
  17. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil.
  18. Hospital Universitário da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil.
  19. Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte-MG, Brazil.
  20. Hospital Geral de Fortaleza (HGF), Fortaleza-CE, Brazil.
  21. Centro Avançado de Pesquisa, Estudos e Diagnóstico (CAPED), Centro Médico Ribeirão shopping, Ribeirão Preto-SP, Brazil.
  22. Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro-RJ, Brazil.
  23. Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE), Recife-PE, Brazil.
  24. Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba (UFPB), João Pessoa-PB, Brazil.
  25. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil.
  26. Hospital Universitário de Brasília da Universidade de Brasília, EBSERH (HUB-UnB), Brasília-DF, Brazil.
  27. Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo-SP, Brazil.
  28. Universidade Federal do Paraná (UFPR), Curitiba-PR, Brazil.
  29. Hospital Universitário Getúlio Vargas Universidade Federal do Amazonas, Manaus-AM, Brazil.
  30. Pontifícia Universidade Católica de Campinas (PUC-CAMP), Campinas-SP, Brazil.
  31. Hospital Universitário Getúlio Vargas Universidade Federal do Amazonas, Manaus-AM, Brazil.
  32. Instituto de Medicina Integral Professor Fernando Figueira (IMIP/PE), Recife-PE, Brazil.
  33. Hospital São Paulo da Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp/EPM), São Paulo-SP, Brazil.
  34. Hospital Universitário Evangélico Mackenzie (HUEM), Curitiba-PR, Brazil.
  35. Hospital Universitário da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil.
  36. Hospital Universitário Cassiano Antonio de Moraes, Universidade Federal do Espírito Santo, Vitória-ES, Brazil.
  37. Instituto Leônidas & Maria Deane, Fiocruz, Manaus-AM, Brazil.
  38. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil.
  39. Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte-MG, Brazil.

CER14790
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PMID: 34251312 [PubMed]

Received: 10/05/2021
Accepted : 07/06/2021
In Press: 07/07/2021

Abstract

OBJECTIVES:
To evaluate the incidence of COVID-19 and its main outcomes in rheumatic disease (RD) patients on hydroxychloroquine (HCQ) compared to household cohabitants (HC).
METHODS:
This is a 24-week nationwide prospective multi-centre cohort with a control group without RD and not using HCQ. All participants were monitored through scheduled phone interviews performed by health professionals. Details regarding COVID-19 symptoms, and epidemiological, clinical, and demographic data were recorded on a specific web-based platform. COVID-19 was defined according to the Brazilian Ministry of Health criteria and classified as mild, moderate or severe.
RESULTS:
A total of 9,585 participants, 5,164 (53.9%) RD patients on HCQ and 4,421 (46.1%) HC were enrolled from March 29th, 2020 to September 30th, 2020, according to the eligibility criteria. COVID-19 confirmed cases were higher in RD patients than in cohabitants [728 (14.1%) vs. 427 (9.7%), p<0.001] in a 24-week follow-up. However, there was no significant difference regarding outcomes related to moderate/ severe COVID-19 (7.1% and 7.3%, respectively, p=0.896). After multiple adjustments, risk factors associated with hospitalisation were age over 65 (HR=4.5; 95%CI 1.35-15.04, p=0.014) and cardiopathy (HR=2.57; 95%CI 1.12-5.91, p=0.026). The final survival analysis demonstrated the probability of dying in 180 days after a COVID-19 diagnosis was significantly higher in patients over 65 years (HR=20.8; 95%CI 4.5-96.1) and with 2 or more comorbidities (HR=10.8; 95%CI 1.1-107.9 and HR=24.8; 95%CI 2.5-249.3, p=0.006, respectively).
CONCLUSIONS:
Although RD patients have had a higher COVID-19 incidence than individuals from the same epidemiological background, the COVID-19 severity was related to traditional risk factors, particularly multiple comorbidities and age, and not to underlying RD and HCQ.

Rheumatology Article