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?:abstract
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Study Objectives: Emergency physicians and other specialists are in critical need of medicinal agents to prevent SARS-COVID-2 (COVID-19) infection International attention has been given to hydroxychloroquine (HCQ), in particular, and other antirheumatologic agents for this purpose Several very commonly used medications work to block the cascade of chemotactic influences and macrophage activation, but definitive prevention of ARDS is inconclusive Agents proposed include TNF blocking agents, leukotriene antagonists and steroids It may be possible to block infection, pneumonia and ARDS with prior use of these agents The objective of this study is to compare attack rates of COVID-19 among patients who were already taking common rheumatologic agents prior to the COVID epidemic in the study region and those not taking these agents Methods: A retrospective cohort design Data was used across multiple hospitals in MI 990 patients with lupus (SLE) or rheumatoid arthritis (RA) and a COVID-19 test (whether negative or positive) were included Agents chosen for analysis included HCQ, infliximab, adalimumab, montelukast and steroids Unadjusted differences between treatment groups with chi-square or Fisher Exact tests were used Use of all agents other than HCQ and montelukast were combined as one group for comparative analysis Adjusted treatment effects were estimated using logistic regression Predictive covariates for the latter included demographics and Charlson comorbidities Influenza testing was also evaluated Results: After dropping N = 30 patients with no data on pre-COVID prescriptions, a sample size of N = 960 patients with an existing diagnosis of rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) were analyzed Of these patients, N = 214 patients had an active HCQ prescription at admission and N = 82 patients had a positive COVID-19 test result None of the unadjusted or adjusted outcomes were statistically different between the \'pretreatment\' groups (on-agent or off-agent) for HCQ for other rheumatological agents tested as a group, or for steroids Conclusion: In a retrospective observational study, there was no evidence of benefit for the prophylactic use of hydroxychloroquine, several representative rheumatologic agents or steroids for the prevention of infection with COVID-19
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