Hydroxychloroquine Does Not Prevent COVID-19 Infection in Patients With Rheumatic Diseases

Researchers assessed whether patients with rheumatic diseases receiving hydroxychloroquine therapy were at a lower risk for SARS-CoV-2 infection.

Chronic hydroxychloroquine therapy did not have a preventative effect against COVID-19 infection in patients with rheumatic conditions compared with those without rheumatic conditions, according to study findings published in American Journal of the Medical Sciences.

Researchers in Oklahoma conducted a retrospective, nationwide, observational study across all Veterans Health Administration (VHA) sites across the United States to compare risk of contracting COVID-19 infection in patients with rheumatic diseases receiving chronic hydroxychloroquine therapy vs those without rheumatic diseases who were not receiving hydroxychloroquine.

Researchers identified data from 6047 patients with rheumatic diseases and 33,081 patients without rheumatic diseases in the VHA database. Rheumatic diseases included rheumatoid arthritis, lupus, and associated rheumatologic conditions, based on International Classification of Diseases, Tenth Revision (ICD10) codes designated between October 2016 and March 2020. The researchers matched 5474 patients into treatment and control groups.

Patients with rheumatic conditions received exclusive treatment with hydroxychloroquine (at least four 90-day supplies between April 2019 and March 2020).

Incidence of COVID-19 infection did not differ between the hydroxychloroquine and the nonhydroxychloroquine group (0.749% and 0.658%, respectively; odds ratio [OR], 1.14; 95% CI, 0.73-1.79; P =.59).

Overall mortality (OR, 1.0; 95% CI, 0.83-1.19) and COVID-19-associated mortality (OR, 0.87; 95% CI, 0.17-4.60) did not significantly differ between the groups. Two variables — body mass index of at least 30 and race other than Caucasian — independently increased risk for COVID-19 infection (OR, 2.03; 95% CI, 1.28-3.27 and OR, 1.61; 95% CI, 1.01-2.57, respectively). Hydroxychloroquine therapy was not found to have an effect on COVID-19 infection (OR, 0.99; 95% CI, 0.62-1.56)

Study limitations included the retrospective study design, lack of randomization, potential confounding of results due to the use of immunomodulating agents in both the groups, the possibility that veterans sought care outside of the VHA for COVID-19 infection, and the lack of generalizability of results outside of the veteran population, which predominantly included men.

“This adds to the growing body of evidence recommending against the use of hydroxychloroquine for the prophylaxis of COVID-19 disease,” the study authors said. “Future efforts evaluating pharmacologic prevention strategies should focus on agents that have demonstrated clinical benefit in treatment,” they added.


Gentry CA, Thind SK, Williams RJ, Hendrickson SC, Kurdgelashvili G, Humphrey MB. Development of SARS-CoV-2 infection in patients with rheumatic conditions on hydroxychloroquine monotherapy vs patients without rheumatic conditions: a retrospective, propensity-matched cohort study. Am J Med Sci. Published online September 11, 2022. doi:10.1016/j.amjms.2022.08.006