Acute QT Interval Modifications During Hydroxychloroquine-Azithromycin Treatment
in the Context of COVID-19 Infection
#MMPMID32753141
Voisin O
; Lorc'h EL
; Mahé A
; Azria P
; Borie MF
; Hubert S
; Ménage E
; Guillerm JC
; Mourad JJ
Mayo Clin Proc
2020[Aug]; 95
(8
): 1696-1700
PMID32753141
show ga
Among candidate drugs to treat coronavirus disease 2019 (COVID-19), the
combination of hydroxychloroquine (HCQ) and azithromycin (AZ) has received
intense worldwide attention. Even as the efficacy of this combination is under
evaluation, clinicians have begun to use it largely. As these medications are
known to prolong the QT interval, we analyzed serial electrocardiograms recorded
in patients hospitalized for COVID-19 pneumonia and treated with HCQ + AZ. Fifty
consecutive patients received the combination of HCQ (600 mg/d for 10 days) and
AZ (500 mg/d on day 1 and 250 mg/d from day 2 to day 5). Twelve-lead
electrocardiograms were recorded before treatment, at day 3, at day 5, and at
discharge. The median age of patients was 68 years (interquartile range, 53-81
years); 28 (56%) were men. The main comorbidities were hypertension (36%; n=18)
and diabetes (16%; n=8). The mean corrected QT (QTc) interval was 408 ms at
baseline and increased up to 437 ms at day 3 and to 456 ms at day 5. Thirty-eight
patients (76%) presented short-term modifications of the QTc duration (>30 ms).
Treatment discontinuation was decided in 6 patients (12%), leading to QTc
normalization in 5 of them. No deaths and no cardiac arrhythmic events were
observed in this cohort. Our report confirms that a short duration treatment with
HCQ + AZ modifies the QTc interval. The treatment had to be discontinued for QTc
modifications in 12% of patients. Nevertheless, in inpatients hospitalized for
COVID-19, we did not observe any clinically relevant consequences of these
transitory modifications. In conclusion, when patients are treated with HCQ + AZ,
cardiac monitoring should be regularly performed and hospital settings allow
monitoring under in safe conditions.
|*Betacoronavirus
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Antiviral Agents/*adverse effects/therapeutic use
[MESH]
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