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All Studies   Meta Analysis    Recent:   

Arrhythmic safety of hydroxychloroquine in COVID-19 patients from different clinical settings

Gasperetti et al., EP Europace, doi:10.1093/europace/euaa216
Sep 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
Safety study of 649 patients finding that HCQ administration is safe for 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.
Arrhythmic safety data from a large cohort of patients treated with HCQ alone or in combination with other QT-prolonging drugs.
Gasperetti et al., 24 Sep 2020, peer-reviewed, 23 authors.
This PaperHCQAll
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.
References
Ben-Zvi, Kivity, Langevitz, Shoenfeld, Hydroxychloroquine: from malaria to autoimmunity, Clin Rev Allergy Immunol
Bessie `re, Roccia, Delinie `re, Charrie `re, Chevalier et al., Assessment of QT intervals in a case series of patients with coronavirus disease 2019 (COVID-19) infection treated with hydroxychloroquine alone or in combination with azithromycin in an intensive care unit, JAMA Cardiol, doi:10.1001/jamacardio.2020.1787
Bethel, Yang, Li, Nahman, Oliver et al., Hydroxychloroquine in patients with systemic lupus erythematosus with endstage renal disease, J Invest Med
Biot, Daher, Chavain, Fandeur, Khalife et al., Design and synthesis of hydroxyferroquine derivatives with antimalarial and antiviral activities, J Med Chem
Burrell, Martinez, Chloroquine and hydroxychloroquine in the treatment of cardiac arrhythmias, N Engl J Med
Cao, Wang, Wen, Liu, Wang, A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19, N Engl J Med
Chatre, Roubille, Vernhet, Jorgensen, Pers, Cardiac complications attributed to chloroquine and hydroxychloroquine: a systematic review of the literature, Drug Safety
Gao, Tian, Yang, Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies, BioSci Trends
Gautret, Lagier, Parola, Hoang, Meddeb et al., Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents, doi:10.1016/j.ijantimicag.2020.105949
Geleris, Sun, Platt, Zucker, Baldwin et al., Observational study of hydroxychloroquine in hospitalized patients with Covid-19, N Engl J Med
Lai, Shih, Ko, Tang, Hsueh, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges, Int J Antimicrob Agents
Mercuro, Yen, Shim, Maher, Mccoy et al., Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease 2019 (COVID-19), JAMA Cardiol, doi:10.1001/jamacardio.2020.1834
Rana, Lim, Naas, Ogston, Newton et al., QT interval abnormalities are often present at diagnosis in diabetes and are better predictors of cardiac death than ankle brachial pressure index and autonomic function tests, Heart
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Simpson, Salazar, Vittinghoff, Probert, Iwahashi et al., Association of QT-prolonging medications with risk of autopsy-defined causes of sudden death, JAMA Intern Med
Teixeira, Borba, Pedrosa, Nishioka, Viana et al., Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus, Europace
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' '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 &amp;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' ' </jats:sec>', 'DOI': '10.1093/europace/euaa216', 'type': 'journal-article', 'created': {'date-parts': [[2020, 7, 3]], 'date-time': '2020-07-03T19:27:29Z', 'timestamp': 1593804449000}, 'page': '1855-1863', 'source': 'Crossref', 'is-referenced-by-count': 25, 'title': 'Arrhythmic safety of hydroxychloroquine in COVID-19 patients from different clinical settings', 'prefix': '10.1093', 'volume': '22', 'author': [ { 'ORCID': 'http://orcid.org/0000-0003-3432-070X', 'authenticated-orcid': False, 'given': 'Alessio', 'family': 'Gasperetti', 'sequence': 'first', 'affiliation': [ { 'name': 'Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, ' 'Italy'}, { 'name': 'University Heart Center, University Hospital Zürich, Zürich, ' 'Switzerland'}]}, { 'given': 'Mauro', 'family': 'Biffi', 'sequence': 'additional', 'affiliation': [ { 'name': 'Unit of Cardiology, Department of Experimental, Diagnostic and ' 'Specialty Medicine-DIMES, University of Bologna, Bologna, ' 'Italy'}]}, { 'given': 'Firat', 'family': 'Duru', 'sequence': 'additional', 'affiliation': [ { 'name': 'University Heart Center, University Hospital Zürich, Zürich, ' 'Switzerland'}]}, { 'given': 'Marco', 'family': 'Schiavone', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi ' 'Sacco Hospital, University of Milan, Milan, Italy'}]}, { 'given': 'Matteo', 'family': 'Ziacchi', 'sequence': 'additional', 'affiliation': [ { 'name': 'Unit of Cardiology, Department of Experimental, Diagnostic and ' 'Specialty Medicine-DIMES, University of Bologna, Bologna, ' 'Italy'}]}, { 'given': 'Gianfranco', 'family': 'Mitacchione', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi ' 'Sacco Hospital, University of Milan, Milan, Italy'}]}, { 'given': 'Carlo', 'family': 'Lavalle', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Cardiovascular Disease, Policlinico Umberto I ' 'Hospital, Rome, Italy'}]}, { 'given': 'Ardan', 'family': 'Saguner', 'sequence': 'additional', 'affiliation': [ { 'name': 'University Heart Center, University Hospital Zürich, Zürich, ' 'Switzerland'}]}, { 'given': 'Antonio', 'family': 'Lanfranchi', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi ' 'Sacco Hospital, University of Milan, Milan, Italy'}]}, { 'given': 'Giacomo', 'family': 'Casalini', 'sequence': 'additional', 'affiliation': [ { 'name': 'III Division of Infectious Diseases, ASST-Fatebenefratelli ' 'Sacco, Department of Biomedical and Clinical Sciences, ' 'University of Milan, Italy'}]}, { 'given': 'Marco', 'family': 'Tocci', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Cardiovascular Disease, Policlinico Umberto I ' 'Hospital, Rome, Italy'}]}, { 'given': 'Davide', 'family': 'Fabbricatore', 'sequence': 'additional', 'affiliation': [{'name': 'Division of Cardiology, Spedali Civili Hospital, Brescia, Italy'}]}, { 'given': 'Francesca', 'family': 'Salghetti', 'sequence': 'additional', 'affiliation': [{'name': 'Division of Cardiology, Spedali Civili Hospital, Brescia, Italy'}]}, { 'given': 'Marco Valerio', 'family': 'Mariani', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Cardiovascular Disease, Policlinico Umberto I ' 'Hospital, Rome, Italy'}]}, { 'given': 'Mattia', 'family': 'Busana', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Anesthesiology, Emergency and Intensive Care ' 'Medicine, University of Göttingen, Göttingen, Germany'}]}, { 'given': 'Alfonso', 'family': 'Bellia', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Systems Medicine, University of Rome ‘Tor ' 'Vergata’, Rome, Italy'}]}, { 'given': 'Chiara Beatrice', 'family': 'Cogliati', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Luigi Sacco Hospital, ' 'University of Milan, Milan, Italy'}]}, { 'given': 'Pierluigi', 'family': 'Viale', 'sequence': 'additional', 'affiliation': [ { 'name': 'Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, ' 'Italy'}, { 'name': 'Unit of Infectious Diseases, Department of Medical and Surgical ' 'Sciences, S. 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