Investigating the effects of remdesivir on corrected QT interval in patients with severe COVID-19 disease: a historical cohort study

Background There is little information about the risk of drug-induced QT prolongation by remdesivir as the most important FDA approved anti COVID-19 drug. Prolongation of corrected QT interval (QTc) is considered as an indicator of an unfavorable outcome which may ultimately induce torsade de pointes and provoke ventricular fibrillation. The aim of this study was to determine the effects of remdesivir on QTc in patients with severe COVID 19 disease. Methods A historical cohort study was conducted on 249 patients who experienced severe COVID-19 disease and were candidate for treatment by intravenous remdesivir. We obtained a 12 lead electrocardiogram at the admission time and five days later to find any significant change in QTc and QT interval following therapy. We took blood samples at the time of hospitalization and then every day to determine the serum levels of electrolytes, complete blood count, fasting blood sugar (FBS), creatinine (Cr), and complete blood count. Results The results of this analysis showed blood pressure and heart rate (HR) were lower and total white blood cells and neutrophil counts, FBS and Cr levels were higher at fifth day than first day of study (P value < 0.001). Furthermore, QT interval was more prolonged at fifth day compared with beginning of remdesivir therapy (379.51 +/- 34.90ms vs. 366.72 +/- 30.97ms, P value < 0.001). However, QTc was not significantly increased at fifth day in comparison with first day (402.37 +/- 33.62ms vs. 400.76 +/- 30.18ms, P value = 0.524 by Bazett's formula and 402.81 +/- 36.33 vs. 400.78 +/- 32.49, P value = 0.459 by Fridericia's formula). Conclusions The current study found no evidence linking the administration of remdesivir with prolongation of the QTc interval.