Hydroxychloroquine Ineffective at Preventing COVID-19 in Rheumatoid Arthritis

Background with viruses – the concept of microbiology and virology
Researchers assessed whether hydroxychloroquine concentration levels in patients with rheumatoid arthritis (RA) affects the incidence of COVID-19 or its complications.

Hydroxychloroquine (HCQ) plasma concentrations did not prevent COVID-19 infection nor lessen COVID-19 symptoms in patients with rheumatoid arthritis (RA) regularly treated with HCQ, according to study findings published in Saudi Pharmaceutical Journal.

Researchers obtained plasma samples from 13 patients diagnosed with RA to measure plasma concentration levels of HCQ and to determine the correlation between HCQ levels and COVID-19 incidence and outcomes. They included patients with RA who received either 200 mg (n=7) or 400 mg (n=6) of HCQ daily for at least 6 months prior to the study.

Six of the 13 (46%) patients contracted COVID-19. Of these, 3 patients received the 200 mg daily dose of HCQ and 3 patients received the 400 mg daily dose. None of the study patients required hospitalization for COVID-19. The most commonly experienced symptoms were mild to moderate, and included fever, fatigue, headache, dry cough, and loss of taste or smell.

The mean HCQ plasma concentrations of patients with RA who received 200 mg doses and did not contract COVID-19 did not significantly differ from those who had COVID-19 (200.45 ± 15.73 ng/mL vs. 209.66 ± 42.04 ng/mL). Similarly, the mean HCQ plasma concentrations patients who received 400 mg doses and did not contract COVID-19 did not significantly differ from those who had COVID-19 (331.87 ± 35.97 ng/mL vs. 361.79 ± 56.65 ng/mL).

Limitations of the study included small sample size, the challenge of recruiting eligible patients, and the possibility of residual confounding due to the use of disease-modifying antirheumatic drugs.

The study authors concluded, “We found no evidence that HCQ plasma concentrations were associated with either preventing COVID-19 incidence or reducing its complications…. Our findings contribute to the growing body of evidence that HCQ is ineffective at preventing or mitigating COVID-19 infection.”


Walibi IA, Alqhanti H, Alqahtani F, et al. The relationship between hydroxychloroquine plasma concentration and COVID-19 outcomes in rheumatoid arthritis patients in Saudi Arabia. Saudi Pharm J. Published online May 23, 2022. doi:10.1016/j.jsps.2022.05.006