An evaluation of co-use of chloroquine or hydroxychloroquine plus azithromycin on cardiac outcomes: A pharmacoepidemiological study to inform use during the COVID19 pandemic.
Adolescent
Adult
Aged
Azithromycin
/ administration & dosage
COVID-19
/ epidemiology
Chloroquine
/ administration & dosage
Cohort Studies
Drug Therapy, Combination
/ adverse effects
Female
Heart Diseases
/ chemically induced
Humans
Hydroxychloroquine
/ administration & dosage
Male
Middle Aged
Pharmacoepidemiology
/ methods
Retrospective Studies
Risk Factors
Young Adult
COVID-19 Drug Treatment
CI, confidence interval
COPD, Chronic obstructive pulmonary disease
COVID19
Cardiac events
Chloroquine
FDA, U.S. Food & Drug Administration
HR, hazard ratio
Hydroxychloroquine
QTc prolongation
SCA/VA, sudden cardiac arrest and ventricular arrhythmias
SIPTW, Standardized inverse probability treatment weighting
Journal
Research in social & administrative pharmacy : RSAP
ISSN: 1934-8150
Titre abrégé: Res Social Adm Pharm
Pays: United States
ID NLM: 101231974
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
27
04
2020
accepted:
28
04
2020
pubmed:
16
5
2020
medline:
29
12
2020
entrez:
16
5
2020
Statut:
ppublish
Résumé
Chloroquine or hydroxychloroquine (chloroquine) plus azithromycin is considered as therapy for COVID-19. With benefit evaluations underway, safety concerns due to potential additive effects on QTc prolongation should be addressed. We compared risk of cardiac adverse events between combinations of chloroquine and azithromycin and chloroquine and amoxicillin. We conducted a retrospective cohort study using the IBM MarketScan Commercial Claims and Medicare Supplemental Databases, 2005-2018. We included autoimmune disease patients aged ≥18 years initiating azithromycin or amoxicillin for ≥5 days during chloroquine treatment. Patients had continuous insurance coverage ≥6 months before combination use until 5 days thereafter or inpatient death. Two outcomes were sudden cardiac arrest/ventricular arrhythmias (SCA/VA) and cardiac symptoms. We followed patients for up to 5 days to estimate hazard ratios (HR). Covariates were adjusted using stabilized inverse probability treatment weighting. We identified two SVC/VA events among >145,000 combination users. The adjusted incidence of cardiac symptoms among azithromycin and amoxicillin users was 276 vs 254 per 10,000 person-years with an adjusted HR of 1.10 (95%CI, 0.62-1.95). Combination use of chloroquine and azithromycin at routine doses did not show pronounced increases in arrhythmias in this real-world population, though small sample size and outcome rates limit conclusions.
Sections du résumé
Background
Chloroquine or hydroxychloroquine (chloroquine) plus azithromycin is considered as therapy for COVID-19. With benefit evaluations underway, safety concerns due to potential additive effects on QTc prolongation should be addressed.
Objective
We compared risk of cardiac adverse events between combinations of chloroquine and azithromycin and chloroquine and amoxicillin.
Methods
We conducted a retrospective cohort study using the IBM MarketScan Commercial Claims and Medicare Supplemental Databases, 2005-2018. We included autoimmune disease patients aged ≥18 years initiating azithromycin or amoxicillin for ≥5 days during chloroquine treatment. Patients had continuous insurance coverage ≥6 months before combination use until 5 days thereafter or inpatient death. Two outcomes were sudden cardiac arrest/ventricular arrhythmias (SCA/VA) and cardiac symptoms. We followed patients for up to 5 days to estimate hazard ratios (HR). Covariates were adjusted using stabilized inverse probability treatment weighting.
Results
We identified two SVC/VA events among >145,000 combination users. The adjusted incidence of cardiac symptoms among azithromycin and amoxicillin users was 276 vs 254 per 10,000 person-years with an adjusted HR of 1.10 (95%CI, 0.62-1.95).
Conclusion
Combination use of chloroquine and azithromycin at routine doses did not show pronounced increases in arrhythmias in this real-world population, though small sample size and outcome rates limit conclusions.
Identifiants
pubmed: 32409150
pii: S1551-7411(20)30468-X
doi: 10.1016/j.sapharm.2020.04.031
pmc: PMC7190482
pii:
doi:
Substances chimiques
Hydroxychloroquine
4QWG6N8QKH
Azithromycin
83905-01-5
Chloroquine
886U3H6UFF
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2012-2017Subventions
Organisme : NIA NIH HHS
ID : P30 AG028740
Pays : United States
Informations de copyright
© 2020 Elsevier Inc. All rights reserved.
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