Antimalarial use and arrhythmias in COVID-19 and rheumatic patients: A matter of dose and inflammation?

Gian Luca Erre, Edoardo Sean Ferraccioli, Matteo Piga, Arduino Mangoni, Giuseppe Passiu, Elisa Gremese, Gianfranco Ferraccioli

Research output: Contribution to journalLetterpeer-review

7 Citations (Scopus)


We read with great interest the paper by Graef and colleagues, ‘Festina lente: hydroxychloroquine, covid-19 and the role of the rheumatologist’.1 As the authors correctly point out, despite firm evidence that their efficacy and safety are lacking,2 antimalarials are being widely prescribed for the treatment of patients with COVID-19. This, as also underlined with some concern by the European League Against Rheumatism President Iain McInness,3 has rapidly led to antimalarial supply shortages worldwide, primarily affecting patients with rheumatic disease, such as those with systemic lupus erythematosus and rheumatoid arthritis (RA). In these groups, low-dose antimalarials (hydroxychloroquine up to 6 mg/kg/day and chloroquine up to 4 mg/kg/day) are the mainstay to control immunological response and to prevent flare in view of their favourable efficacy and safety profile.
Original languageEnglish
Article numbere217828
Number of pages2
JournalAnnals of the Rheumatic Diseases
Issue number3
Early online date18 May 2020
Publication statusPublished - 1 Mar 2021


  • antirheumatic agents
  • cardiovascular diseases
  • hydroxychloroquine


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