Key result
Hydroxychloroquine plus azithromycin is linked to ~50% higher incidence of prolonged QTc versus hydroxychloroquine alone.
Why the study?
The incidence of QT interval prolongation among COVID-19 patients treated with hydroxychloroquine alone versus in combination with azithromycin was unclear.
Does hydroxychloroquine in combination with azithromycin increase QT interval prolongation compared to hydroxychloroquine alone in COVID-19 patients?
Cohort (n=100)
Yes
Does hydroxychloroquine in combination with azithromycin increase QT interval prolongation compared to hydroxychloroquine alone in COVID-19 patients?
Absolute Event Rate: 30% vs 20%
p-value: p=<0.05
Combination therapy with hydroxychloroquine and azithromycin in COVID-19 patients is associated with a higher incidence and magnitude of QTc prolongation compared to hydroxychloroquine monotherapy.
Combination therapy may heighten QT prolongation risk versus HCQ alone in COVID-19; leaves open need for randomized outcome trials.
Objective: The aim of this study is to compare the incidence of increase QT interval among COVID 19 patients treated with hydroxychloroquin alone and combination with azithromycin. Study Design: Retrospective Cohort Study Place and Duration: It is a multicenter study and conducted in cardiology departments of Farooq Hospital, Lahore, Govt Zakir Khan Shaheed Hospital Matta Swat and Category A Hospital, Batkhela Malakand for duration from March 2020 to February 2021. Methods: Total 100 Covid-19 patients of both genders were enrolled in this study. Patients details demographics age, sex and body mass index were recorded after taking informed written consent. Patients were divided into two groups. Group I had 50 patients and received hydroxychloroquin and group II (50 patients) received hydroxychloroquin with azithromycin. Outcomes among both groups were assessed in terms of increase QT interval. Complete data was analyzed by SPSS 24.0 version. Results: There were 32 (64%) males and 18 (36%) females in group I while in group II 30 (60%) males and 20 (40%) females. Mean age in group I was 57.65±9.87 years with mean BMI 28.18±4.23 kg/m2 and in group II mean age was 61.09±6.26 years with mean BMI 29.18±6.53 kg/m2. Hypertension was the most common co-morbidity found in 60%and 56% in group I and II followed by diabetes 26% and 28% among both groups. Prolong QTc was found among 10 (20%) cases in group I and in Group II 15 (30%) patients. Significantly QTc was increase in group II from 443.18±26.23 to 475.13±29.36 while in group I QTc increases from 442.37±33.25 to 468.09±26.37 ms. Among 15 cases in combination group 9 patients had change QTc of >500 milliseconds and 2 cases had QTc of > delta 60 ms while in monotherapy group 4 cases had change QTc of 500 milliseconds and 1 had > delta 60 milliseconds. Conclusion: We concluded in this study that prolonged QTc and change of QTc was significantly higher in COVID 19 patients who received treatment with combination of hydroxychloroquin and azithromycin as compared to the patients who received hydroxychloroquin only.
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Rahman et al. (2021) conducted a cohort in COVID-19 (n=100). Hydroxychloroquine and azithromycin vs. Hydroxychloroquine alone was evaluated on Prolonged QTc (increase of >60 ms or QTc ≥ 500 ms) (p=<0.05). Treatment with a combination of hydroxychloroquine and azithromycin significantly increased the incidence of prolonged QTc compared to hydroxychloroquine alone in COVID-19 patients (30% vs 20%, p<0.05).
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