The current outbreak of COVID-19 represents a source of concern for the management of systemic lupus erythematous, SLE, patients. These patients have an increased risk of severe infections due to their underlying disease, the use of immunosuppressive drugs, as well as the potential presence of organ damage associated with their disease.
Hydroxychloroquine, HCQ, a drug that is currently part of the long-term care treatment for SLE, has been reported to possess anti-viral activity in vitro and recent publications have suggested a beneficial effect on COVID-19.
The EULAR Journal, The Annals of the Rheumatic Diseases, publishes a letter this week regarding the impact of COVID-19 on SLE patients taking hydoxychloroquine: ‘Clinical course of Coronavirus Disease 2019 (COVID-19) in a series of 17 systemic lupus erythematous patients under long-term treatment with hydroxychloroquine’.
EULAR Past-President Professor Johannes W. Bijlsma comments: “This gives a first clinical picture of the course of COVID-19 in SLE patients treated with HCQ. It paves the way for a larger observational study to identify the risk factors associated with the occurrence of a severe form of COVID-19 in patients with SLE. Our preliminary conclusion, based on the observation that most of the SLE patients in this study received long-term treatment with HCQ, having blood concentrations of the drug within therapeutic range, is that HCQ does not seem to prevent COVID-19, at least its severe forms, in patients with SLE.”
Medicine shortages are a significant challenge for people with rheumatic and musculoskeletal diseases in the ongoing situation around COVID-19. Data collected by EULAR shows that a majority of countries in Europe have encountered and are still encountering serious shortages of hydroxychloroquine (HCQ), and that shortages in essential medicines were also encountered before the COVID-19 pandemic. EULAR advises that the unrestricted access to HCQ for a possible COVID-19 prophylaxis in the absence of evidence from clinical trial data should be avoided and the drug rather continue to be available for those who are in need of it, for example for use in the case of a disease in which it has already been long approved.
Systemic Lupus Erythematous is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary from mild to severe and can include painful and swollen joints among other factors. There are often periods of illness, called flares, as well as remission in which there are fewer symptoms.
EULAR has launched the COVID-19 rheumatic and musculoskeletal diseases reporting database, a European paediatric and adult database to monitor and report outcomes of COVID-19 occurring in patients with rheumatic and musculoskeletal diseases with the support of the Global Rheumatology Alliance: https://www.eular.org/eular_covid19_database.cfm
EULAR has released guidance for patients in the context of the COVID-19 outbreak.The guidance addresses typical questions that patients with RMDs have and recommends protective measures both for patients and the health care workforce.