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Risk of coronavirus disease 2019 hospitalization and mortality in rheumatic patients treated with hydroxychloroquine or other conventional disease-modifying anti-rheumatic drugs in Italy.
Spila Alegiani, Stefania; Crisafulli, Salvatore; Giorgi Rossi, Paolo; Mancuso, Pamela; Salvarani, Carlo; Atzeni, Fabiola; Gini, Rosa; Kirchmayer, Ursula; Belleudi, Valeria; Kurotschka, Peter Konstantin; Leoni, Olivia; Ludergnani, Monica; Ferroni, Eliana; Baracco, Susanna; Massari, Marco; Trifirò, Gianluca.
  • Spila Alegiani S; Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy.
  • Crisafulli S; Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
  • Giorgi Rossi P; Italian Society of Pharmacology, Milan, Italy.
  • Mancuso P; Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Salvarani C; Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Atzeni F; Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Gini R; Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy.
  • Kirchmayer U; Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy.
  • Belleudi V; Agenzia Regionale di Sanità della Toscana, Florence, Italy.
  • Kurotschka PK; Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Rome, Italy.
  • Leoni O; Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Rome, Italy.
  • Ludergnani M; Department of Medical Sciences and Public Health, Faculty of Medicine and Surgery, University of Cagliari, Cagliari, Italy.
  • Ferroni E; Regional Health Trust of Sardinia Region, Cagliari, Italy.
  • Baracco S; Epidemiology Observatory-Department of Health of Lombardy Region, Milan, Italy.
  • Massari M; Epidemiology Observatory-Department of Health of Lombardy Region, Milan, Italy.
  • Trifirò G; Azienda Zero of the Veneto Region, Padua, Italy.
Rheumatology (Oxford) ; 60(SI): SI25-SI36, 2021 10 09.
Article in English | MEDLINE | ID: covidwho-1462486
Semantic information from SemMedBD (by NLM)
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ABSTRACT

OBJECTIVES:

To ascertain if the use of hydroxychloroquine(HCQ)/cloroquine(CLQ) and other conventional DMARDs (cDMARDs) 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. The risk of COVID-19-related outcomes was estimated using a multivariate conditional logistic regression analysis comparing HCQ/CLQ vs MTX, vs other cDMARDs and vs non-use of these drugs. The presence of rheumatic diseases vs their absence in a non-nested population was investigated.

RESULTS:

A total of 1275 patients hospitalized due to COVID-19 were matched to 12 734 controls. Compared with recent use of MTX, no association between HCQ/CLQ monotherapy and COVID-19 hospitalization [odds ratio (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 with 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 MTX 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. The 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 due to immunosuppressive action.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Rheumatic Diseases / Antirheumatic Agents / COVID-19 / Hospitalization / Hydroxychloroquine Type of study: Etiology study / Observational study / Randomized controlled trials / Risk factors / Screening study Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Europa Language: English Journal: Rheumatology (Oxford) Journal subject: Rheumatology Year: 2021 Document Type: Article Affiliation country: Rheumatology

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Rheumatic Diseases / Antirheumatic Agents / COVID-19 / Hospitalization / Hydroxychloroquine Type of study: Etiology study / Observational study / Randomized controlled trials / Risk factors / Screening study Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: Europa Language: English Journal: Rheumatology (Oxford) Journal subject: Rheumatology Year: 2021 Document Type: Article Affiliation country: Rheumatology