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The impact of hydroxychloroquine and azithromycin on the corrected qt interval in patients with the novel coronavirus disease 2019
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Abstract
Background
Although long-term use of HCQ and AZT has been reported to cause QT prolongation and malign arrhythmia, there is not enough data about the effect of short-term use on arrhythmia. Purpose: The aim of this study was to assess the effect of HCQ alone and HCQ + AZT on corrected QT (QTc).Methods: A baseline ECG and on-treatment ECGs were retrospectively collected in COVID-19 patients who received HCQ and/or AZT. Also peak QTc intervals of monotherapy and combination therapy was compared. Results: Of the 155 patients included, 102 (65.8%) were using HCQ, 53 (34.2%) were using HCQ + AZT combination. The use of both HCQ alone and HCQ + AZT combined therapy significantly prolonged the QTc and the QTc interval was significantly longer in patients received combination therapy. QTc prolongation caused early termination in both groups, 5 (4.9%) patients in the monotherapy group and in 6 (11.3%) patients in the combined therapy group.Conclusion: Patients who received HCQ for COVID-19 were at high risk of QTc prolongation, and concurrent treatment with AZT was associated with greater changes in QTc.
Comparison of baseline characteristics a
| Characteristic | Total (n = 155) | Hydroxychloroquine (n = 102) | Hydroxychloroquine /Azithromycin (n = 53) | P value |
|---|---|---|---|---|
| Length of stay at ward, SD | 9.54 ± 4.28 | 9.64 ± 4.31 | 9.31 ± 4.25 | 0.88 |
| Length of stay Intensive care unite,SD | 7.92 ± 3.76 | 7.18 ± 3.18 | 8.46 ± 4.15 | 0.29 |
| Radiographic findings of pneumonia | 118(76.1%) | 76(74.5%) | 42(49.2%) | 0.32 |
| Mechanically ventilation | 16(10.3%) | 7(6.9%) | 9(17.0%) | 0.049 |
| In hospital death | 19(12.3%) | 10(9.8%) | 9(17.0%) | 0.15 |
| ECG findings median(IQR) (ms) | ||||
| Baseline QRS duration | 91.0(80.0-103.0) | 92.5(80.75-105.50) | 90.0(80.0-102.5) | 0.5 |
| Posttreatment QRS peak | 97.0(86.0-109.0) | 97.5(88.0-109.25) | 95.0(85.5-109) | 0.68 |
| ΔQRS | 4.0(0.0-9.0) | 2.0(0.0-8.25) | 5.0(1.0-9.5) | 0.14 |
| Baseline QTc duration | 407.0(385.0-426.0) | 408.0(389.25-427.50) | 404.0(384.0-420.0) | 0.1 |
| Posttreatment QTc peak | 437.0(414.0-460.0) | 428.0(412.75-449.25) | 456.0(422.0-467.5) | <0.001 |
| ΔQTc | 27.0(13.0-45.0) | 18.0(11.0-30.0) | 46.0(40.5-54.5) | <0.001 |
| Baseline PR duration | 145.50(128.7-160.0) | 147.0(135.0-160.0) | 144.0(120.0-160.0) | 0.53 |
| Posttreatment PR peak | 159.0(140.0-170.0) | 159.0(141.0-168.50) | 156.0(139.5-171.0) | 0.97 |
| ΔPR | 7.0(1.0-13.0) | 5.0(0.0-12.25) | 10.0(5.0-15.0) | 0.022 |
| QTc peak day | 5.0(4.0-5.0) | 5.0(4.0-6.0) | 4.0(3.0-5.0) | 0.022 |
| Drug withdrawl due to QRS prolongation | 11(7.1%) | 5(4.9%) | 6(11.3%) | 0.12 |