Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection.
Anti-Bacterial Agents
/ adverse effects
Antimalarials
/ adverse effects
Arrhythmias, Cardiac
/ chemically induced
Azithromycin
/ adverse effects
Betacoronavirus
COVID-19
Chloroquine
/ adverse effects
Coronavirus Infections
/ drug therapy
Drug Therapy, Combination
Electrocardiography
/ drug effects
Follow-Up Studies
Humans
Hydroxychloroquine
/ adverse effects
Incidence
Pandemics
Pneumonia, Viral
/ drug therapy
Prospective Studies
Risk Factors
SARS-CoV-2
United States
/ epidemiology
COVID-19
QT prolongation
azithromycin
chloroquine
hydroxychloroquine
pandemic
Journal
Circulation. Arrhythmia and electrophysiology
ISSN: 1941-3084
Titre abrégé: Circ Arrhythm Electrophysiol
Pays: United States
ID NLM: 101474365
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
pubmed:
30
4
2020
medline:
3
7
2020
entrez:
30
4
2020
Statut:
ppublish
Résumé
The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine±azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death. Hospitalized patients treated with chloroquine/hydroxychloroquine±azithromycin from March 1 to the 23 at 3 hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in Torsade de pointes. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation, and arrhythmogenic death. Two hundred one patients were treated for coronavirus disease 2019 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine, and 119 (59.2%) also received azithromycin. The primary outcome of torsade de pointes was not observed in the entire population. Baseline corrected QT interval intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) versus those treated with combination group (chloroquine/hydroxychloroquine and azithromycin; 440.6±24.9 versus 439.9±24.7 ms, In the largest reported cohort of coronavirus disease 2019 patients to date treated with chloroquine/hydroxychloroquine±azithromycin, no instances of Torsade de pointes, or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.
Sections du résumé
BACKGROUND
The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine±azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death.
METHODS
Hospitalized patients treated with chloroquine/hydroxychloroquine±azithromycin from March 1 to the 23 at 3 hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in Torsade de pointes. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation, and arrhythmogenic death.
RESULTS
Two hundred one patients were treated for coronavirus disease 2019 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine, and 119 (59.2%) also received azithromycin. The primary outcome of torsade de pointes was not observed in the entire population. Baseline corrected QT interval intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) versus those treated with combination group (chloroquine/hydroxychloroquine and azithromycin; 440.6±24.9 versus 439.9±24.7 ms,
CONCLUSIONS
In the largest reported cohort of coronavirus disease 2019 patients to date treated with chloroquine/hydroxychloroquine±azithromycin, no instances of Torsade de pointes, or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.
Identifiants
pubmed: 32347743
doi: 10.1161/CIRCEP.120.008662
pmc: PMC7299095
doi:
Substances chimiques
Anti-Bacterial Agents
0
Antimalarials
0
Hydroxychloroquine
4QWG6N8QKH
Azithromycin
83905-01-5
Chloroquine
886U3H6UFF
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e008662Références
Circulation. 1964 Jul;30:17-26
pubmed: 14197832
Emerg Microbes Infect. 2020 Dec;9(1):221-236
pubmed: 31987001
Lancet Infect Dis. 2007 Aug;7(8):549-58
pubmed: 17646028
N Z Med J. 2003 Nov 07;116(1185):U666
pubmed: 14615808
Expert Opin Drug Metab Toxicol. 2011 Sep;7(9):1153-67
pubmed: 21736423
Virol J. 2005 Aug 22;2:69
pubmed: 16115318
J Am Heart Assoc. 2016 Jun 17;5(6):
pubmed: 27317349
Lancet Infect Dis. 2020 May;20(5):565-574
pubmed: 32213337
Pacing Clin Electrophysiol. 2005 Nov;28(11):1221-2
pubmed: 16359290
Pacing Clin Electrophysiol. 2007 Dec;30(12):1579-82
pubmed: 18070319
Malar J. 2009 Dec 10;8:289
pubmed: 20003315
N Engl J Med. 2012 May 17;366(20):1881-90
pubmed: 22591294
Lancet. 2020 Feb 22;395(10224):565-574
pubmed: 32007145
Front Cardiovasc Med. 2018 Aug 03;5:106
pubmed: 30123799
J Physiol. 2016 May 1;594(9):2459-68
pubmed: 26660066
Med Clin (Barc). 2001 Jun 23;117(3):118-9
pubmed: 11459586
Acta Biomed. 2006 Apr;77(1):30-2
pubmed: 16856707
Cell Mol Life Sci. 2004 Nov;61(21):2738-43
pubmed: 15549175
Pacing Clin Electrophysiol. 2001 Oct;24(10):1572-4
pubmed: 11707055
Clin Infect Dis. 2020 Jul 28;71(15):732-739
pubmed: 32150618
Clin Toxicol (Phila). 2006;44(2):173-5
pubmed: 16615675
J Interv Card Electrophysiol. 2007 Apr;18(3):243-6
pubmed: 17546486
Lancet. 1993 Jun 12;341(8859):1541-2
pubmed: 8099420
Drug Saf. 2001;24(8):575-85
pubmed: 11480490
J Clin Rheumatol. 2013 Aug;19(5):286-8
pubmed: 23872551
J Virol. 2020 Mar 17;94(7):
pubmed: 31996437
Circ Arrhythm Electrophysiol. 2017 Apr;10(4):
pubmed: 28408648
Pacing Clin Electrophysiol. 1998 May;21(5):1029-34
pubmed: 9604234
HeartRhythm Case Rep. 2020 Apr 01;6(5):244-248
pubmed: 32363145
Europace. 2014 Jan;16(1):101-8
pubmed: 23833046
Postgrad Med. 2018 Nov;130(8):660-665
pubmed: 30145917
Acta Clin Belg. 2019 Feb;74(1):41-47
pubmed: 30220246