Cardiovascular Safety of Hydroxychloroquine-Azithromycin in 424 COVID-19 Patients
Matthieu Million, Jean-Christophe Lagier, Jérôme Hourdain, Frédéric Franceschi, Jean-Claude Deharo, Philippe Parola, Philippe Brouqui
doi:10.20944/preprints202303.0325.v1
Background: Hydroxychloroquine (HCQ) combined with azithromycin (AZM) has been widely administered to patients with COVID-19 despite scientific controversies. In particular the potential to prolong cardiac repolarisation by using this combination has been discussed. Materials and methods: We report a pragmatic and simple safety approach which we implemented in the first patients treated for COVID-19 in our center early 2020. Treatment contraindications were the presence of severe structural or electrical heart disease, baseline corrected QT interval (QTc) >500 ms, hypokalaemia, or other drugs prolonging QTc that could not be interrupted. Electrocardiogram and QTc was evaluated at admission and re-evaluated after 48 hours of the initial prescription. Results: Among 424 consecutive adults (mean age 46.3 ± 16.1 years; 216 women), 21.5% patients were followed in conventional wards and 78.5% in a day-care unit. A total of 11 patients (2.6%) had contraindications to HCQ-AZ combination. In the remaining 413 treated patients, there were no arrhythmic events in any patient during the 10-day treatment regimen. QTc was slightly but statistically significantly prolonged by 3.75 ± 25.4 ms after two days (p=0.003). Ten patients (2.4%) developed QTc prolongation >60 ms, and none had QTc >500 ms. Conclusions: This report does not aim to contribute to knowledge of the efficacy of treating COVID-19 with HCQ-AZ. However, a simple initial assessment of patient medical history, ECG and kalemia identifies contraindicated patients and enables the safe treatment by HCQ-AZ of COVID-19 patients. QTprolonging anti-infective drugs can be used safely in acute lifethreatening infections, provided that a strict protocol and close collaboration between infectious disease specialists and rhythmologists is applied. Disclaimer/Publisher's Note: The statements, opinions, and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions, or products referred to in the content.
Conflicts of Interest: None of the authors declare have any conflicts of interest to declare.
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'abstract': '<jats:p>Background Hydroxychloroquine (HCQ) combined with azithromycin (AZM) has been widely '
'administered to patients with COVID-19 despite scientific controversies. In particular the '
'potential to prolong cardiac repolarisation by using this combination has been discussed. '
'Materials and methods We report a pragmatic and simple safety approach which we implemented '
'in the first patients treated for COVID-19 in our center early 2020. Treatment '
'contraindications were the presence of severe structural or electrical heart disease, '
'baseline corrected QT interval (QTc) &gt;500 ms, hypokalaemia, or other drugs prolonging '
'QTc that could not be interrupted. Electrocardiogram and QTc was evaluated at admission and '
're-evaluated after 48 hours of the initial prescription. Results Among 424 consecutive adults '
'(mean age 46.3 &plusmn; 16.1 years; 216 women). Patients were followed in conventional '
'wards (21.5%) or in a day-care unit (78.5%). A total of 11 patients (2.6%) had '
'contraindications to HCQ-AZ combination. In the remaining 413 treated patients, there were no '
'arrhythmic events in any patient during the 10-day treatment regimen. QTc was slightly but '
'statistically significantly prolonged by 3.75 &plusmn; 25.4 ms after two days (p=0.003). '
'Ten patients (2.4%) developed QTc prolongation &gt;60 ms, and none had QTc &gt;500 '
'ms. Conclusions This report do not aim to contribute to knowledge of the efficacy of treating '
'COVID-19 with HCQ-AZ. However, a simple initial assessment of patient medical history, ECG '
'and kalaemia identifies contraindicated patients and enables the safe treatment by HCQ-AZ of '
'COVID-19 patients. QT-prolonging anti-infective drugs can be used safely in acute '
'life-threatening infections, provided that a strict protocol and close collaboration between '
'infectious disease specialists and rhythmologists are followed.</jats:p>',
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