Cardiovascular Safety of Hydroxychloroquine-Azithromycin in 424 COVID-19 Patients

被引:2
|
作者
Million, Matthieu [1 ,2 ]
Lagier, Jean-Christophe [1 ,2 ]
Hourdain, Jerome [3 ,4 ]
Franceschi, Frederic [3 ,4 ]
Deharo, Jean-Claude [3 ,4 ]
Parola, Philippe [1 ,5 ]
Brouqui, Philippe [1 ,2 ]
机构
[1] IHU Mediterranee Infect, F-13005 Marseille, France
[2] Aix Marseille Univ, AP HM, Fac Sci Med & Paramed, Inst Rech Dev,Unite MEPHI Microbes Evolut Phylogen, F-13005 Marseille, France
[3] Ctr Hosp Univ Timone, AP HM, Serv Cardiol, F-13005 Marseille, France
[4] Aix Marseille Univ, Fac Sci Med & Paramed, C2VN, F-13005 Marseille, France
[5] Aix Marseille Univ, AP HM, Fac Sci Med & Paramed, VITROME,IRD, F-13005 Marseille, France
来源
MEDICINA-LITHUANIA | 2023年 / 59卷 / 05期
关键词
COVID-19; SARS-CoV-2; hydroxychloroquine; azithromycin; QTc interval; cardiac rhythm; safety; torsades de pointe; COMBINATION; THERAPY;
D O I
10.3390/medicina59050863
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background and Objectives: Hydroxychloroquine (HCQ) combined with azithromycin (AZM) has been widely administered to patients with COVID-19 despite scientific controversies. In particular, the potential of prolong cardiac repolarization when using this combination has been discussed. Materials and Methods: We report a pragmatic and simple safety approach which we implemented among the first patients treated for COVID-19 in our center in early 2020. Treatment contraindications were the presence of severe structural or electrical heart disease, baseline corrected QT interval (QTc) > 500 ms, hypokalemia, or other drugs prolonging QTc that could not be interrupted. Electrocardiogram and QTc was evaluated at admission and re-evaluated after 48 h of the initial prescription. Results: Among the 424 consecutive adult patients (mean age 46.3 +/- 16.1 years; 216 women), 21.5% patients were followed in conventional wards and 78.5% in a day-care unit. A total of 11 patients (2.6%) had contraindications to the HCQ-AZ combination. In the remaining 413 treated patients, there were no arrhythmic events in any patient during the 10-day treatment regimen. QTc was slightly but statistically significantly prolonged by 3.75 +/- 25.4 ms after 2 days of treatment (p = 0.003). QTc prolongation was particularly observed in female outpatients <65 years old without cardiovascular disease. Ten patients (2.4%) developed QTc prolongation > 60 ms, and none had QTc > 500 ms. Conclusions: This report does not aim to contribute to knowledge of the efficacy of treating COVID-19 with HCQ-AZ. However, it shows that a simple initial assessment of patient medical history, electrocardiogram (ECG), and kalemia identifies contraindicated patients and enables the safe treatment of COVID-19 patients with HCQ-AZ. QT-prolonging anti-infective drugs can be used safely in acute life-threatening infections, provided that a strict protocol and close collaboration between infectious disease specialists and rhythmologists are applied.
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页数:12
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