Hydroxychloroquine in COVID-19 Ups Risk for QTc Prolongation

Concurrent treatment with azithromycin linked to greater changes in corrected QT interval.

HealthDay News – Patients with COVID-19 who receive hydroxychloroquine have a high risk for corrected QT (QTc) prolongation, according to a study published online May 1 in JAMA Cardiology.

Nicholas J. Mercuro, PharmD, from the Beth Israel Deaconess Medical Center in Boston, and colleagues conducted a cohort study at an academic tertiary care center in Boston to characterize the risk and degree of QT prolongation associated with hydroxychloroquine with or without concomitant azithromycin in adult patients hospitalized for COVID-19. Ninety patients were given hydroxychloroquine and 53 received concomitant azithromycin.

The median baseline QTc was 455 ms (hydroxychloroquine, 473 ms vs hydroxychloroquine and azithromycin, 442 ms). The researchers found that compared with those receiving hydroxychloroquine alone, those receiving concomitant azithromycin had a greater median change in QT interval (23 versus 5.5 ms). Seven and three of 37 patients who received hydroxychloroquine monotherapy developed prolonged QTc of 500 ms or more and had a change in QTc of 60 ms or more, respectively; the corresponding proportions were 11 and seven of 53 patients who received concomitant azithromycin. Those who received concomitant loop diuretics or had a baseline QTc of 450 ms or more had an increased likelihood of prolonged QTc (adjusted odds ratios, 3.38 and 7.11, respectively).

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“There is a critical need for rigorous, large-scale studies and risk-benefit assessment prior to initiating COVID-19 therapeutics, with careful attention to medication interactions, cardiac manifestations, routine electrocardiograms, and electrolyte monitoring,” the authors write.

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