Key result
Treatment with hydroxychloroquine and azithromycin in 413 COVID-19 patients resulted in no arrhythmic events and a slight mean QTc prolongation of 3.75 ms (p=0.003).
Why the study?
Hydroxychloroquine combined with azithromycin was widely administered for COVID-19 despite scientific controversies, particularly concerns regarding its potential to prolong cardiac repolarization.
Does hydroxychloroquine combined with azithromycin cause arrhythmic events or significant QTc prolongation in adult patients with COVID-19?
Observational (n=424)
No
Does hydroxychloroquine combined with azithromycin cause arrhythmic events or significant QTc prolongation in adult patients with COVID-19?
Mean Difference: 3.75
p-value: p=0.003
A simple initial assessment of patient medical history, ECG, and kalemia enables the safe treatment of COVID-19 patients with hydroxychloroquine and azithromycin without severe arrhythmic events.
Early pragmatic QT-monitoring protocol for HCQ-AZM appears feasible; leaves open whether it reduces arrhythmic events in larger populations.
Background and Objectives: Hydroxychloroquine (HCQ) combined with azithromycin (AZM) has been widely administered to patients with COVID-19 despite scientific controversies. In particular, the potential of prolong cardiac repolarization when using this combination has been discussed. Materials and Methods: We report a pragmatic and simple safety approach which we implemented among the first patients treated for COVID-19 in our center in early 2020. Treatment contraindications were the presence of severe structural or electrical heart disease, baseline corrected QT interval (QTc) > 500 ms, hypokalemia, or other drugs prolonging QTc that could not be interrupted. Electrocardiogram and QTc was evaluated at admission and re-evaluated after 48 h of the initial prescription. Results: Among the 424 consecutive adult patients (mean age 46.3 ± 16.1 years; 216 women), 21.5% patients were followed in conventional wards and 78.5% in a day-care unit. A total of 11 patients (2.6%) had contraindications to the HCQ-AZ combination. In the remaining 413 treated patients, there were no arrhythmic events in any patient during the 10-day treatment regimen. QTc was slightly but statistically significantly prolonged by 3.75 ± 25.4 ms after 2 days of treatment (p = 0.003). QTc prolongation was particularly observed in female outpatients <65 years old without cardiovascular disease. Ten patients (2.4%) developed QTc prolongation > 60 ms, and none had QTc > 500 ms. Conclusions: This report does not aim to contribute to knowledge of the efficacy of treating COVID-19 with HCQ-AZ. However, it shows that a simple initial assessment of patient medical history, electrocardiogram (ECG), and kalemia identifies contraindicated patients and enables the safe treatment of COVID-19 patients with HCQ-AZ. QT-prolonging anti-infective drugs can be used safely in acute life-threatening infections, provided that a strict protocol and close collaboration between infectious disease specialists and rhythmologists are applied.
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Million et al. (2023) conducted an observational in COVID-19 (n=424). Hydroxychloroquine and azithromycin was evaluated on QTc prolongation after 2 days of treatment (MD 3.75 ms, p=0.003). Treatment with hydroxychloroquine and azithromycin in 413 COVID-19 patients resulted in no arrhythmic events and a slight mean QTc prolongation of 3.75 ms (p=0.003).
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