Hydroxychloroquine and azithromycin: As a double edge sword for COVID-19?
Retrospective 172 hospitalized patients, 83% treated and HCQ+AZ and 17% with HCQ, not finding a significant difference in QTc prolongation, but recommending careful monitoring for the use of HCQ+AZ; especially in males, patients with high-risk Tisdale score, and in patients who have baseline QTc interval ≥ 450 milliseconds.
Eftekhar et al., 26 Jan 2021, preprint, 6 authors.
Abstract: medRxiv preprint doi: https://doi.org/10.1101/2021.01.16.21249941; this version posted January 26, 2021. The copyright holder for this preprint (which was not certified by
peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY 4.0 International license .
Hydroxychloroquine and azithromycin: As a double edge sword for COVID-19?
Seyed Parsa Eftekhar1, Sohrab Kazemi2, Mohammad Barary1, Mostafa Javanian3, Soheil Ebrahimpour3, Naghmeh Ziaei4 *
1- Student Research Committee, Health Research Center, Babol University of Medical Sciences, Babol, Iran.
2- Cellular and Molecular Biology Research Center, Health Research Center, Babol University of Medical Sciences, Babol,
Iran.
3- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical
Sciences, Babol, I.R. Iran.
4- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran.
*Corresponding Author:
Naghmeh Ziaei, Department of Cardiology, Babol University of Medical Sciences, Babol, Iran, Tel: +989111131748, Email: (ziaiexn@yahoo.com).
Abstract
Background: Hydroxychloroquine with or without azithromycin was one of the common therapies at the beginning of the
COVID-19 pandemic. They can prolong QT interval, cause Torsade de pointes, and lead to sudden cardiac death. We
aimed to assess QT interval prolongation and its risk factors in patients who received hydroxychloroquine with or without
azithromycin.
Methods: This was a retrospective cohort study. 172 patients with COVID-19 included, hospitalized at hospitals of Babol
University of Medical Sciences between March 5, 2020, and April 3, 2020. Patients were divided into two groups:
hydroxychloroquine alone and hydroxychloroquine with azithromycin. Electrocardiograms were used for outcome
assessment.
Results: 83.1% of patients received hydroxychloroquine plus azithromycin vs 16.9% of patients who received only
hydroxychloroquine. The mean age of patients was 59.2 ± 15.4. The mean of post-treatment QTc interval in the
monotherapy group was shorter than the mean of post-treatment QTc interval in the combination therapy group but it had
no significant statistical difference (462.5 ± 43.1 milliseconds vs 464.3 ± 59.1 milliseconds; P = 0.488). Generally, 22.1%
of patients had a prolonged QTc interval after treatment. Male gender, or baseline QTc ≥ 450 milliseconds, or high-risk
Tisdale score increased the likelihood of prolonged QTc interval. Due to QTc prolongation, 14 patients did not continue
therapy after 4 days.
Conclusion: Hospitalized patients treated with hydroxychloroquine with or without azithromycin, had no significant
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
difference in prolongation
of QT interval and outcome. But the number of patients with prolonged QT intervals in this
study emphasizes careful cardiac monitoring during therapy; especially in high-risk patients.
Keywords: Hydroxychloroquine, Azithromycin, QTc interval, Torsade de pointes, COVID-19, novel coronavirus
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