Produção Nacional
Revisado por pares
POS1252 COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES ON CHRONIC USE OF HYDROXYCHLOROQUINE IN A LARGE BRAZILIAN COHORT – A 24-WEEK PROSPECTIVE STUDY
2021; BMJ; Volume: 80; Issue: Suppl 1 Linguagem: Inglês
10.1136/annrheumdis-2021-eular.3727
ISSN1468-2060
AutoresGecilmara Salviato Pileggi, G. Ferreira, Ana Paula Monteiro Gomides, E. Reis Neto, Mirhelen Mendes de Abreu, Cleandro Pires de Albuquerque, Nafice Costa Araújo, Ana Beatriz Santos Bacchiega, Dante Valdetaro Bianchi, Blanca Elena Ríos Gomes Bica, Eloísa Bonfá, Eduardo Ferreira Borba, Danielle Christinne Soares Egypto de Brito, Ana Maria Tavares Duarte, M. Peixoto Gu e Silva de Souza, Kirla Wagner Poti Gomes, Adriana María Kakehasi, Rafaela Cavalheiro do Espírito Santo, P. Realle, Evandro Mendes Klumb, Cristina Costa Duarte Lanna, C.D.L. Marques, Odirlei André Monticielo, L. Mota, Gabriela Araújo Munhoz, E.S. Paiva, H. Pereira, José Roberto Provenza, S. Ribeiro, LAURINDO FERREIRA ROCHA, Camila Santana Justo Cintra Sampaio, Vanderson de Souza Sampaio, Emília Inoue Sato, Thelma Larocca Skare, Viviane de Oliveira Nogueira Souza, Valéria Valim, Marcus Lacerda, Ricardo Machado Xavier, Marcelo M. Pinheiro,
Tópico(s)Hematological disorders and diagnostics
ResumoBackground: The role of chronic use of hydroxychloroquine (HCQ) in rheumatic disease (RD) patients during the SARS-CoV-2 pandemic is still subject of discussion. Objectives: To compare the occurrence of COVID-19 and its outcomes between RD patients on HCQ use with individuals from the same household not taking the drug during community viral transmission in an observational prospective multicenter study in Brazil. Methods: Participants were enrolled and monitored through 24-week (From March 29 th to Sep 30 th , 2020) regularly scheduled phone calls performed by trained medical professionals. Epidemiological and demographic data, as well as RD disease activity status and current treatment data, specific information about COVID-19, hospitalization, need for intensive care, and death was recorded in both groups and stored in the Research Electronic Data Capture (REDCap) database. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. The statistical analysis was performed using IBM-SPSS v.20.0 software. Group comparisons were made using the Man-Whitney, Chi-Square and Fisher Exact Test, as well as multivariate regression models adjusted to confounders. Survival curves were performed using Kaplan-Meier analysis. Results: A total of 10,427 participants mean age (SD) of 44.04 (14.98) years were enrolled, including 6004 (57.6%) rheumatic disease patients, of whom 70.8% had systemic lupus erythematosus (SLE), 6.7% rheumatoid arthritis (RA), 4% primary Sjögren’s syndrome (pSS), 1.8% mixed connective tissue disease (DMTC), 1% systemic sclerosis (SSc) and others (15.9), including overlap syndromes. In total, 1,132 (10.8%) participants fulfilled criteria for COVID-19, being 6.7% RD patients and 4.1% controls (p=0.002). A recent influenza vaccination had a protective role (p<0.001). Moderate and severe COVID-19 included the need for hospitalization, intensive care, mechanical ventilation or death. Infection severity was not different between groups (p=0.391) (Table 1). After adjustments for multiple confounders, the main risk factors significantly associated with COVID-19 were higher education level (OR=1.29 95%CI 1.05-1.59), being healthcare professionals (OR=1.91; 95%CI 1.45-2.53), presence of two comorbidities (OR=1.31; 95%CI 1.01-1.66) and three or more comorbidities associated (OR=1.69; 95%CI 1.23-2.32). Interestingly, age >=65 years (OR=0.20; 95%CI 0.11-0.34) was negatively associated. Regarding RD, the risk factors associated with COVID-19 diagnosys were SLE (OR= 2.37; 95%CI 1.92-293), SSc (OR=2.25; 95%CI 1.05-4.83) and rituximab use (OR=1.92; 95%CI 1.13-3.26). In addition, age >=65 years (OR=5.47; 95%CI 1.7-19.4) and heart disease (OR=2.60; 95%CI 1.06-6.38) were associated with hospitalization. Seven female RD patients died, six with SLE and one with pSS, and the presence of two or more comorbidities were associated with higher mortality rate. Conclusion: Chronic HCQ use did not prevent COVID-19 in RD compared to their household cohabitants. Health care profession, presence of comorbidities LES, SSc and rituximab were identified as main risk factors for COVID-19 and aging and heart disease as higher risk for hospitalization. Our data suggest these outcomes could be considered to manage them in clinical practice. Table 1. Frequency and severity of COVID-19 in patients with rheumatic diseases on chronic use of hydroxychloroquine compared to their household controls COVID-19 outcomes Total (%) Groups P Patients (%) Controls (%) Diagnosis No 9256 (89.1) 5300 (88.3) 3956 (90.2) 0.002 Yes 1132 (10.9) 704 (11.7) 428 (9.8) Severity Mild 1059 (93.6) 662 (94.0) 397 (92.8) 0.391 Moderate 52 (4.6) 32 (4.5) 20 (4.7) Severe 21 (1.9) 10 (1.4) 11 (2.6) HCQ: hydroxychloroquine. Moderate and severe COVID-19 included the need for any of the following: hospitalization, intensive care, mechanical ventilation or death. Acknowledgements: To the Brazilian Society of Rheumatology for technical support and rapid nationwide mobilization. To all the 395 interviewers (medical students and physicians) who collaborated in the study and the participants To CNPq (Number 403442/2020-6) Disclosure of Interests: None declared
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