Article ; Online: Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19.
International journal of antimicrobial agents
2020 Volume 56, Issue 4, Page(s) 106142
Abstract: ... its predicting factors in subjects treated with combinations containing hydroxychloroquine (HCQ) for COVID-19 ... prolongation were observed during pharmacological therapy containing HCQ for COVID-19. Evidence of myocardial ... in women. Patients were treated under strict cardiac supervision. A total of 105 adults were included [56 ...
| Abstract | This longitudinal, prospective cohort study aimed to assess risk of QTc interval prolongation and its predicting factors in subjects treated with combinations containing hydroxychloroquine (HCQ) for COVID-19. Moderate-to-severe QTc prolongation during therapy was defined as a QTc interval >470 ms in men or >480 ms in women. Patients were treated under strict cardiac supervision. A total of 105 adults were included [56% male; median (IQR) age 69 (57-79) years]. All patients received therapy with HCQ in combination with azithromycin (AZM), and 95 (90%) also with lopinavir/ritonavir (LPV/r). Concomitant medications classified as having risk of developing torsades de pointes (TdP) were simultaneously used in 81 patients (77%). Moderate-to-severe QTc prolongation was observed in 14 patients (13%), mostly at Days 3-5 from baseline, with 6 (6%) developing severe prolongation (>500 ms). There was no evidence of TdP arrhythmia or TdP-associated death. Adding LPV/r to HCQ+AZM did not significantly prolong the QTc interval. Multivariable Cox regression revealed that comedications with known risk of TdP (HR = 11.28, 95% CI 1.08-117.41), higher neutrophil-to-lymphocyte (NLR) ratio (HR = 1.10, 95% CI 1.03-1.18 per unit increase) and higher serum hs-cardiac troponin I (HR = 4.09, 95% CI 1.36-12.2 per unit increase) were major contributors to moderate-to-severe QTc prolongation. In this closely screened and monitored cohort, no complications derived from QTc prolongation were observed during pharmacological therapy containing HCQ for COVID-19. Evidence of myocardial injury with elevated troponin and strong inflammatory response, specifically higher NLR, are conditions requiring careful QTc interval monitoring. |
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| MeSH term(s) | Aged ; Anti-Infective Agents/administration & dosage ; Anti-Infective Agents/adverse effects ; Azithromycin/administration & dosage ; Azithromycin/adverse effects ; Betacoronavirus/drug effects ; Betacoronavirus/immunology ; Betacoronavirus/pathogenicity ; Biomarkers/blood ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/drug therapy ; Coronavirus Infections/physiopathology ; Coronavirus Infections/virology ; Disease Progression ; Drug Combinations ; Female ; Humans ; Hydroxychloroquine/administration & dosage ; Hydroxychloroquine/adverse effects ; Intensive Care Units ; Long QT Syndrome/chemically induced ; Long QT Syndrome/diagnosis ; Long QT Syndrome/physiopathology ; Lopinavir/administration & dosage ; Lopinavir/adverse effects ; Lymphocytes/pathology ; Lymphocytes/virology ; Male ; Middle Aged ; Neutrophils/pathology ; Neutrophils/virology ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/drug therapy ; Pneumonia, Viral/physiopathology ; Pneumonia, Viral/virology ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Ritonavir/administration & dosage ; Ritonavir/adverse effects ; SARS-CoV-2 ; Treatment Outcome ; Troponin I/blood |
| Chemical Substances | Anti-Infective Agents ; Biomarkers ; Drug Combinations ; Troponin I ; lopinavir-ritonavir drug combination ; Lopinavir (2494G1JF75) ; Hydroxychloroquine (4QWG6N8QKH) ; Azithromycin (83905-01-5) ; Ritonavir (O3J8G9O825) |
| Keywords | covid19 |
| Language | English |
| Publishing date | 2020-08-24 |
| Publishing country | Netherlands |
| Document type | Journal Article |
| ZDB-ID | 1093977-5 |
| ISSN | 1872-7913 ; 0924-8579 |
| ISSN (online) | 1872-7913 |
| ISSN | 0924-8579 |
| DOI | 10.1016/j.ijantimicag.2020.106142 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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