Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil

Abstract Background: There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods: This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann-Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the presence of COVID-19. Results: From March 29th to May 17st, 2020, a total of 10,443 participants were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren's syndrome and 0.8% systemic sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30 days prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant difference between rheumatic disease patients (4.03%) and controls (3.25%). After adjustments for multiple confounders, the main risk factor significantly associated with a COVID-19 diagnosis was lung disease (OR 1.63; 95% CI 1.03-2.58); and for rheumatic disease patients were diagnosis of systemic sclerosis (OR 2.8; 95% CI 1.19-6.63) and glucocorticoids above 10 mg/ day (OR 2.05; 95% CI 1.31-3.19). In addition, a recent influenza vaccination had a protective effect (OR 0.674; 95% CI 0.46-0.98). Conclusion: Patients with rheumatic disease on hydroxychloroquine presented a similar occurrence of COVID-19 to household cohabitants, suggesting a lack of any protective role against SARS-CoV-2 infection. Trial registration Brazilian Registry of Clinical Trials (ReBEC; RBR - 9KTWX6).

Effect of systemic arterial hypertension and use of antiproteinuric drug in induction therapy for lupus nephritis / Efeito da hipertensão arterial sistêmica com uso de antiproteinúrico na terapia de indução da nefrite lúpica

ABSTRACT Objective To evaluate the therapeutic response to induction treatment in lupus nephritis patients. Methods A total of 29 patients diagnosed with systemic lupus erythematosus and biopsy-proven nephritis were divided into two groups, one with hypertensive individuals and another non-hypertensive patients. The hypertensive patients included were on drugs with antiproteinuric effect. The induction treatment comprised mycophenolate mofetil or cyclophosphamide, based on 24-hour proteinuria and serum creatinine parameters for therapeutic evaluation after 6 months of intervention. The retrospective evaluation of the follow-up was made based on information collected from the medical records. Results Patients with and without hypertension presented similar behaviors of proteinuria (p=0.127) and creatinine (p=0.514) over time. For proteinuria, only the time effect (p=0.007), but not hypertensive effect (p=0.232), was found. There was a reduction in proteinuria levels (reduction by 3.28g/24 hours, on average) from the beginning to the final measurement. As to creatinine, no hypertensive (p=0.757) or time (p=0.154) effects were found. Conclusion Similarity in behavior of proteinuria was observed, after induction treatment for nephritis, taking into account the hypertensive effect. The prior condition did not hinder these patients reaching the recommended proteinuria goal.

RESUMO Objetivo Avaliar resposta terapêutica a tratamento de indução de pacientes com nefrite lúpica. Métodos Foram divididos em dois grupos 29 pacientes com diagnóstico de lúpus eritematoso sistêmico e nefrite comprovada por biópsia, sendo um de portadores de hipertensão e outro sem essa comorbidade. Dentre os hipertensos, foram incluídos aqueles que faziam uso de antiproteinúrico. O tratamento de indução foi realizado com micofenolato de mofetila ou ciclofosfamida, sendo utilizados os parâmetros de proteinúria de 24 horas e creatinina sérica para avaliação terapêutica após 6 meses da intervenção. A avaliação retrospectiva do seguimento foi realizada a partir de informações coletadas de prontuário. Resultados Pacientes com e sem hipertensão apresentaram comportamentos similares de proteinúria (p=0,127) e creatinina (p=0,514) ao longo do tempo. Para a proteinúria, observou-se apenas o efeito de tempo (p=0,007), mas não de hipertensão (p=0,232). Houve redução nos níveis da proteinúria (redução de 3,28g/24 horas, em média) do início para o momento pós. Já para a creatinina, não se observou efeito de hipertensão (p=0,757) e tampouco de tempo (p=0,154). Conclusão Observamos similaridade no comportamento da proteinúria, após tratamento de indução para nefrite, levando em conta o efeito hipertensão. A comorbidade prévia não se mostrou impeditiva para que estes pacientes atingissem a meta de proteinúria preconizada.

Estudo da densidade óssea em pacientes com lúpus eritematoso sistêmico na pré-menopausa / Study of bone density in premenopausal patients with systemic lupus erythematosus

Objetivo: Estudar a densidade óssea na coluna lombar e no colo do fêmur de pacientes com lúpus eritematoso sistêmico (LES) na pré-menopausa e avaliar a influência de corticoterapia e de outros fatores de risco para osteoporose nestas pacientes. Pacientes e métodos: A densidade mineral óssea na coluna lombar (L1-L4) e no colo do fêmur foi medida por densitômetro de dupla emissao com fontes de raios X em 40 pacientes com LES, na pré-menopausa, caucasóides, com média de idade 32,4 anos e média de tempo do doença de 6,8 anos, e no grupo-controle, constituído por 53 mulheres na pré-menopausa, caucasóides, saudáveis, com média de idade 32,5 anos. Resultados: A densidade óssea na coluna lombar foi significativamente menor nas pacientes com LES quando comparada ao grupo-controle. Ao dividirmos as pacientes com LES segundo a dose total e a dose média diária de glicocorticóide (GC) utilizada no último ano, nao houve diferença estatisticamente significante entre as densidade ósseas dessas pacientes. Ao avaliarmos outros fatores que pudessem ter interferido na reduçao da massa óssea da pacientes com LES, nao encontramos associaçao entre densidade óssea e tempo de doença, idade de início da doença, menarca, paridade e ingestao de leite e café. Conclusao: Pacientes com LES apresentaram diminuiçao da densidade mineral óssea na coluna que nao parece estar relacionada à dose de GC e esta diminuiçao talvez seja decorrente da própria doença, devido à açao dos mediadores da inflamaçao