Arrhythmic safety of hydroxychloroquine in COVID-19 patients from different clinical settings
Alessio Gasperetti, Mauro Biffi, Firat Duru, Marco Schiavone, Matteo Ziacchi, Gianfranco Mitacchione, Carlo Lavalle, Ardan Saguner, Antonio Lanfranchi, Giacomo Casalini, Marco Tocci, Davide Fabbricatore, Francesca Salghetti, Marco Valerio Mariani, Mattia Busana, Alfonso Bellia, Chiara Beatrice Cogliati, Pierluigi Viale, Spinello Antinori, Massimo Galli, Nazzareno Galiè, Claudio Tondo, Giovanni Battista Forleo
EP Europace, doi:10.1093/europace/euaa216
The aim of the study was to describe ECG modifications and arrhythmic events in COVID-19 patients undergoing hydroxychloroquine (HCQ) therapy in different clinical settings.
Conclusion HCQ administration, alone or in combination with other potentially QTc-prolonging drugs, proved safe for a short-term treatment of patients with COVID-19 infection, causing only modest QTc prolongation. Serial ECG recordings at 36-72 h and later than 96 h from treatment onset can detect QTc changes that might suggest therapy modification. This experience provides a framework to enable HCQ therapy implementation in different clinical settings for future efficacy trials.
Supplementary material Supplementary material is available at Europace online. Conflict of interest: Dr. A.S. own stocks from Gilead Science inc. The rest of authors declare no conflict of interest.
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:sec>\n'
' <jats:title>Aims</jats:title>\n'
' <jats:p>The aim of the study was to describe ECG modifications and '
'arrhythmic events in COVID-19 patients undergoing hydroxychloroquine (HCQ) therapy in '
'different clinical settings.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Methods and results</jats:title>\n'
' <jats:p>COVID-19 patients at seven institutions receiving HCQ therapy from '
'whom a baseline and at least one ECG at 48+ h were available were enrolled in the study. '
'QT/QTc prolongation, QT-associated and QT-independent arrhythmic events, arrhythmic '
'mortality, and overall mortality during HCQ therapy were assessed. A total of 649 COVID-19 '
'patients (61.9 ± 18.7 years, 46.1% males) were enrolled. HCQ therapy was administrated as a '
'home therapy regimen in 126 (19.4%) patients, and as an in-hospital-treatment to 495 (76.3%) '
'hospitalized and 28 (4.3%) intensive care unit (ICU) patients. At 36–72 and at 96+ h after '
'the first HCQ dose, 358 and 404 ECGs were obtained, respectively. A significant QT/QTc '
'interval prolongation was observed (P &lt; 0.001), but the magnitude of the increase was '
'modest [+13 (9–16) ms]. Baseline QT/QTc length and presence of fever (P = 0.001) at admission '
'represented the most important determinants of QT/QTc prolongation. No arrhythmic-related '
'deaths were reported. The overall major ventricular arrhythmia rate was low (1.1%), with all '
'events found not to be related to QT or HCQ therapy at a centralized event evaluation. No '
'differences in QT/QTc prolongation and QT-related arrhythmias were observed across different '
'clinical settings, with non-QT-related arrhythmias being more common in the intensive care '
'setting.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Conclusion</jats:title>\n'
' <jats:p>HCQ administration is safe for a short-term treatment for patients '
'with COVID-19 infection regardless of the clinical setting of delivery, causing only modest '
'QTc prolongation and no directly attributable arrhythmic deaths.</jats:p>\n'
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