tetano
Editor, Senior Moderator
J Electrocardiol
. 2020 Nov 28;64:30-35.
doi: 10.1016/j.jelectrocard.2020.11.012. Online ahead of print.
Effect of hydroxychloroquine, azithromycin and lopinavir/ritonavir on the QT corrected interval in patients with COVID-19
Julio Echarte-Morales[SUP] 1 [/SUP], Carlos Minguito-Carazo[SUP] 1 [/SUP], Samuel Del Castillo-Garc?a[SUP] 1 [/SUP], Javier Borrego-Rodr?guez[SUP] 1 [/SUP], Miguel Rodr?guez-Santamarta[SUP] 1 [/SUP], Enrique S?nchez-Mu?oz[SUP] 1 [/SUP], Rub?n Bergel-Garc?a[SUP] 1 [/SUP], Clea Gonz?lez-Maniega[SUP] 1 [/SUP], Silvia Prieto-Gonz?lez[SUP] 1 [/SUP], Paula Men?ndez-Suarez[SUP] 1 [/SUP], Elena Tundidor-Sanz[SUP] 1 [/SUP], Tom?s Benito-Gonz?lez[SUP] 2 [/SUP], Felipe Fern?ndez-V?zquez[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Administration of Hydroxychloroquine and Azithromycin in patients with coronavirus disease 2019 (COVID-19) prolongs QTc corrected interval (QTc). The effect and safety of Lopinavir/Ritonavir in combination with these therapies have seldom been studied.
Objectives: Our aim was to evaluate changes in QTc in patients receiving double (Hydroxychloroquine + Azithromycin) and triple therapy (Hydroxychloroquine + Azithromycin + Lopinavir/Ritonavir) to treat COVID-19. Secondary outcome was the incidence of in-hospital all-cause mortality.
Methods: Patients under treatment with double (DT) and triple therapy (TT) for COVID-19 were consecutively included in this prospective observational study. Serial in-hospital electrocardiograms were performed to measure QTc at baseline and during therapy.
Results: 168 patients (?66.2 years old) were included: 32.1% received DT and 67.9% received TT. The mean baseline QTc was 410.33 ms. Patients under DT and TT prolonged QTc interval respect baseline values (p < 0.001), without significant differences between both therapy groups (p = 0.748). Overall, 33 patients (19.6%) had a peak QTc and/or an increase QTc 60 ms from baseline, with a higher prevalence among those with hypokalemia (p = 0.003). All-cause mortality was similar between both strategy groups (p = 0.093) and high risk QTc prolongation was no related to clinical events in this series.
Conclusions: DT and TT prolong the QTc in patients with COVID-19. Addition of Lopinavir/Ritonavir on top of Hydroxychloroquine and Azithromycin did not increase QTc compared to DT.
Keywords: Azithromycin; COVID-19; Hydroxychloroquine; Lopinavir/ritonavir; QT corrected interval.
. 2020 Nov 28;64:30-35.
doi: 10.1016/j.jelectrocard.2020.11.012. Online ahead of print.
Effect of hydroxychloroquine, azithromycin and lopinavir/ritonavir on the QT corrected interval in patients with COVID-19
Julio Echarte-Morales[SUP] 1 [/SUP], Carlos Minguito-Carazo[SUP] 1 [/SUP], Samuel Del Castillo-Garc?a[SUP] 1 [/SUP], Javier Borrego-Rodr?guez[SUP] 1 [/SUP], Miguel Rodr?guez-Santamarta[SUP] 1 [/SUP], Enrique S?nchez-Mu?oz[SUP] 1 [/SUP], Rub?n Bergel-Garc?a[SUP] 1 [/SUP], Clea Gonz?lez-Maniega[SUP] 1 [/SUP], Silvia Prieto-Gonz?lez[SUP] 1 [/SUP], Paula Men?ndez-Suarez[SUP] 1 [/SUP], Elena Tundidor-Sanz[SUP] 1 [/SUP], Tom?s Benito-Gonz?lez[SUP] 2 [/SUP], Felipe Fern?ndez-V?zquez[SUP] 1 [/SUP]
Affiliations
- PMID: 33307378
- DOI: 10.1016/j.jelectrocard.2020.11.012
Abstract
Background: Administration of Hydroxychloroquine and Azithromycin in patients with coronavirus disease 2019 (COVID-19) prolongs QTc corrected interval (QTc). The effect and safety of Lopinavir/Ritonavir in combination with these therapies have seldom been studied.
Objectives: Our aim was to evaluate changes in QTc in patients receiving double (Hydroxychloroquine + Azithromycin) and triple therapy (Hydroxychloroquine + Azithromycin + Lopinavir/Ritonavir) to treat COVID-19. Secondary outcome was the incidence of in-hospital all-cause mortality.
Methods: Patients under treatment with double (DT) and triple therapy (TT) for COVID-19 were consecutively included in this prospective observational study. Serial in-hospital electrocardiograms were performed to measure QTc at baseline and during therapy.
Results: 168 patients (?66.2 years old) were included: 32.1% received DT and 67.9% received TT. The mean baseline QTc was 410.33 ms. Patients under DT and TT prolonged QTc interval respect baseline values (p < 0.001), without significant differences between both therapy groups (p = 0.748). Overall, 33 patients (19.6%) had a peak QTc and/or an increase QTc 60 ms from baseline, with a higher prevalence among those with hypokalemia (p = 0.003). All-cause mortality was similar between both strategy groups (p = 0.093) and high risk QTc prolongation was no related to clinical events in this series.
Conclusions: DT and TT prolong the QTc in patients with COVID-19. Addition of Lopinavir/Ritonavir on top of Hydroxychloroquine and Azithromycin did not increase QTc compared to DT.
Keywords: Azithromycin; COVID-19; Hydroxychloroquine; Lopinavir/ritonavir; QT corrected interval.