Assessing QT interval in COVID-19 patients:safety of hydroxychloroquine-azithromycin combination regimen

• Published in: International journal of cardiology 2021-02, Vol.324, p.242-248
• Main Authors: Bernardini, Andrea, Ciconte, Giuseppe, Negro, Gabriele, Rondine, Roberto, Mecarocci, Valerio, Viva, Tommaso, Santini, Francesca, de Innocentiis, Carlo, Giannelli, Luigi, Witkowska, Ewa, Locati, Emanuela Teresina, Castelvecchio, Serenella, Marrocco-Trischitta, Massimiliano M., Vicedomini, Gabriele, Menicanti, Lorenzo, Pappone, Carlo
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Antimalarials - administration & dosage; Antimalarials - adverse effects; Azithromycin; Azithromycin - administration & dosage; Azithromycin - adverse effects; COVID-19; COVID-19 - chemically induced; COVID-19 - diagnosis; COVID-19 - physiopathology; Drug Therapy, Combination; ECG; Electrocardiography - drug effects; Electrocardiography - trends; Female; Follow-Up Studies; Humans; Hydroxychloroquine; Hydroxychloroquine - administration & dosage; Hydroxychloroquine - adverse effects; Long QT Syndrome - diagnosis; Long QT Syndrome - drug therapy; Male; Middle Aged; Patient Safety; QT interval; Retrospective Studies
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2020.09.038

Hydroxychloroquine (HCQ) and azithromycin (AZT) have been proposed for COVID-19 treatment. Data available in the literature reported a potential increased risk of fatal arrhythmias under these therapies. The aim of this study was to assess the effects of these drugs on QT interval and outcome in a COVID-19 population. A total of 112 consecutive COVID-19 patients were included in this analysis and were divided in 3 groups according to the receiving therapeutic regimens: 19 (17%) patients in Group 1 (no treatment), 40 (36%) in Group 2 (HCQ only), 53 (47%) in Group 3 (HCQ/AZT). A prolonged QTc interval was found in 61% of patients treated with HCQ alone or in combination with AZT, but only 4 (4%) patients showed a QTc > 500 ms. HCQ/AZT combination determined a greater increase of QTc duration compared to the other two strategies (Group 3 452 ± 26.4 vs Group 2 436.3 ± 28.4 vs Group 1 424.4 ± 24.3 ms, respectively; p