Key result
Female COVID-19 patients show longer QTc intervals but hospitalization disparities preclude a clear risk association.
Why the study?
Women have a higher risk for drug-induced TdP, but whether female COVID-19 patients face an elevated risk of QTc prolongation from chloroquine or hydroxychloroquine with or without azithromycin remained unanswered.
Does treatment with chloroquine or hydroxychloroquine with/without azithromycin cause a higher risk of QTc prolongation in female compared to male COVID-19 patients?
Does treatment with chloroquine or hydroxychloroquine with/without azithromycin cause a higher risk of QTc prolongation in female compared to male COVID-19 patients?
While QTc prolongation occurs with antimalarial therapies in COVID-19, current data is insufficient to confirm a significantly higher risk specifically in female patients due to confounding factors and male-predominant hospitalizations.
Women have higher risk for developing TdP in response to ventricular repolarization prolonging drugs. Hundreds of trials are administering chloroquine and hydroxychloroquine with/without azithromycin to COVID-19 patients. While an overall prolonged QTc has been reported in COVID-19 patients undergoing these treatments, the question on even higher QTc elevation risk in thousands of female COVID-19 patients undergoing these treatments remains unanswered. We therefore explore data reported and shared with us to evaluate safety and efficacy of antimalaria pharmacotherapies in female COVID-19 patients. Although we observed longer mean QTc intervals in female patients in 2 of the 3 cohorts reviewed, the sex disproportionality in COVID-19 hospitalizations precludes a clear sex mediated QTc interval elevation risk association in the female COVID-19 patients undergoing acute treatment regimens. Adoption of study designs that include observation of sex mediated differential triggering of cardiac electrical activity by these drugs is warranted.
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Grewal et al. (2020) conducted a review in COVID-19 (n=386). Chloroquine and Hydroxychloroquine with/without Azithromycin vs. Male patients (sex-based comparison) was evaluated on Change in QTc interval (ΔQTc). Although female COVID-19 patients exhibited longer mean QTc intervals in two of three reviewed cohorts, sex disproportionality in hospitalizations precluded a clear sex-mediated QTc elevation risk association.
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