Key result
Hydroxychloroquine plus azithromycin is linked to similar posttreatment QTc intervals versus hydroxychloroquine alone in COVID-19.
Why the study?
Hydroxychloroquine with or without azithromycin was commonly used early in the COVID-19 pandemic and can prolong QT interval, cause torsade de pointes, and lead to sudden cardiac death.
Does hydroxychloroquine with azithromycin increase QT interval prolongation compared to hydroxychloroquine alone in hospitalized COVID-19 patients?
Cohort (n=172)
Yes
Does hydroxychloroquine with azithromycin increase QT interval prolongation compared to hydroxychloroquine alone in hospitalized COVID-19 patients?
In hospitalized COVID-19 patients, adding azithromycin to hydroxychloroquine did not significantly worsen QTc prolongation compared to hydroxychloroquine alone, though overall rates of QTc prolongation were high.
Answers are grounded in this paper and cite their sources.
Azithromycin addition was not associated with greater QTc prolongation; hypothesis-generating for arrhythmia risk in hospitalized COVID-19.
Background. Hydroxychloroquine with or without azithromycin was one of the common therapies at the beginning of the COVID-19 pandemic. They can prolong QT interval, cause torsade de pointes, and lead to sudden cardiac death. We aimed to assess QT interval prolongation and its risk factors in patients who received hydroxychloroquine with or without azithromycin. Methods. This study was a retrospective cohort study. One hundred seventy-two confirmed COVID-19 patients were included in this study, hospitalized at Babol University of Medical Sciences hospitals between March 5, 2020, and April 3, 2020. Patients were divided into two groups: hydroxychloroquine alone and hydroxychloroquine with azithromycin. Electrocardiograms were used for outcome assessment. Results. 83.1% of patients received hydroxychloroquine plus azithromycin vs. 16.9% of patients who received only hydroxychloroquine. The mean age of patients was <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mn>59.2</a:mn> <a:mo>±</a:mo> <a:mn>15.4</a:mn> </a:math> .The mean of posttreatment QTc interval in the monotherapy group was shorter than the mean of posttreatment QTc interval in the combination therapy group, but it had no significant statistical difference ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mn>462.5</c:mn> <c:mo>±</c:mo> <c:mn>43.1</c:mn> </c:math> milliseconds vs. <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mn>464.3</e:mn> <e:mo>±</e:mo> <e:mn>59.1</e:mn> </e:math> milliseconds; <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>p</g:mi> <g:mo>=</g:mo> <g:mn>0.488</g:mn> </g:math> ). Generally, 22.1% of patients had a prolonged QTc interval after treatment. Male gender, or baseline <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mtext>QTc</i:mtext> <i:mo>≥</i:mo> <i:mn>450</i:mn> </i:math> milliseconds, or high-risk Tisdale score increased the likelihood of prolonged QTc interval. Due to QTc prolongation, fourteen patients did not continue therapy after four days. Conclusions. Hospitalized patients treated by hydroxychloroquine with or without azithromycin had no significant difference in prolongation of QT interval and outcome. The numbers of patients with prolonged QT intervals in this study emphasize careful cardiac monitoring during therapy, especially in high-risk patients.
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Eftekhar et al. (2021) conducted a cohort in COVID-19 (n=172). Hydroxychloroquine with azithromycin vs. Hydroxychloroquine alone was evaluated on Posttreatment QTc interval (p=0.488). Hydroxychloroquine with azithromycin resulted in a similar posttreatment QTc interval compared to hydroxychloroquine alone in hospitalized COVID-19 patients.
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