Six months following the beginning of Covid-19 pandemic in China, data on the risk of SARS-CoV-2 infection among patients with autoimmune rheumatic diseases are now available. However, the rapid spread of the pandemic has not allowed proper design of prospective studies, thus evidence came mostly from case series and observational studies.
The early enthusiasm on hydroxychloroquine (HCQ) anti-viral properties should not suggest that patients who are long-term treated with antimalarials, such as patients with systemic lupus erythematosus (SLE), are protected against SARS-CoV-2 infection. Indeed, a French report on 17 HCQ-treated SLE patients dampened the enthusiasm.1
A recent report from Covid-19 Global Rheumatology Alliance has described 80 SLE patients with Covid-19, mostly females under 65 years of age, 64% of whom were already taking HCQ before the infection: the rate of hospitalisation and the need for intensive care did not differ between patients who were and those who were not taking HCQ.2 A study group from Northern Italy – the Italian epicentre of the pandemic – reported an incidence of 2.5% of Covid-19 (higher compared to the general population of the same region) in 165 patients with SLE.3
Patients with SLE are possibly at risk of developing symptomatic or severe Covid-19, not only because of their disease or treatment but as a consequence of associated comorbidities known to worsen the outcome of SARS-COv-2 infection.4 5
What do we know so far? SLE patients should not withdraw their medication. Before drawing any other conclusion, large registry data are needed to clarify the incidence and the outcome of Covid-19 in patients with SLE.
Describe the current evidence for risk of SARS-CoV-2 infection among patients with autoimmune rheumatic diseases, notably SLE
Explain why it is important to ensure robust evidence are available to clarify the outcome of Covid-19 in patients with SLE
Mathian A, Mahevas M, Rohmer J, et al. Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine. Ann Rheum Dis 2020;79(6):837–39.
Konig MF, Kim AH, Scheetz MH, et al. Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19. Ann Rheum Dis 2020 doi: 10.1136/annrheumdis-2020-217690 [published Online First: 2020/05/10].
Bozzalla Cassione E, Zanframundo G, Biglia A, et al. COVID-19 infection in a northern-Italian cohort of systemic lupus erythematosus assessed by telemedicine. Ann Rheum Dis 2020 doi: 10.1136/annrheumdis-2020-217717 [published Online First: 2020/05/14].
Wallace B, Waher L, Correspondence regarding Research Letter to the Editor by Mathian A, et al. ‘Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus under long-term treatment with hydroxychloroquine’. Ann Rheum Dis 2020. doi:10.1136/annrheumdis-2020-217794.
Gianfrancesco M, Hyrich KL, Al-Adely S, et al. 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 2020;79(7):859–66.
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