Cardiovascular Safety of Hydroxychloroquine–Azithromycin in 424 COVID-19 Patients
Abstract
:1. Introduction
2. Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Molecules | Indications in Infectious Diseases |
---|---|
Polyenes Amphotericin B | Fungal infections |
Antimalarial combinations Artemether/lumefantrine Artenimol/piperaquine | Malaria |
HIV Protease inhibitors Atazanavir Lopinavir/ritonavir Nelfinavir Saquinavir | HIV |
Macrolides Azithromycin b Clarithromycin Erythromycin Roxithromycin Telithromycin | Bacterial infections |
Diarylquinolines Bedaquiline | Tuberculosis |
Antimalarial quinolines Chloroquine Hydroxychloroquine b Primaquine Quinine | Malaria, Q fever |
Quinolones Ciprofloxacin Levofloxacin Moxifloxacin Norfloxacin Ofloxacin | Bacterial infections |
Leprostatics Clofazimine | Mycobacterial infection |
NNRTIs Efavirenz | HIV |
Azole antifungals Fluconazole Posaconazole Voriconazole | Fungal infections |
Meglumine antimoniate | Leishmaniosis |
Amebicides and miscellaneous antibiotics Metronidazole | Amoebiasis and anaerobic bacterial infections |
Antipseudomonal penicillins Piperacillin/tazobactam | Bacterial infections |
Purine nucleosides Remdesivir | COVID-19 |
Sulfonamides Sulfamethoxazole and trimethoprime | Bacterial and parasitic infections |
Item | Contraindication a | Safe Prescription of HCQ-AZM |
---|---|---|
Patient interview: cardiac history | Severe structural or electrical heart disease a | - Absence of history of severe cardiopathy associated with increased risk of torsade de pointe |
Patient interview: co-medications | Co-medication of HCQ-AZ with QTc-prolonging drugs b | - Patients without QTc-prolonging drugs- Patients for whom QT-prolonging therapy could be discontinued for 10 days |
Initial 12-lead ECG | Baseline corrected QT interval > 500 ms, channelopathy, Brugada syndrome, pathological Q waves, left ventricular hypertrophy, and left bundle branch block.Any abnormal ECG after cardiological advice c | - Patients with normal ECG- Patients with abnormal ECG but no contraindication to HCQ-AZ after cardiological advice c |
Kalemia | Dyskalemia (K+ <3.6 mmol/L or K+ >5 mmol/L) d | - Patients without dyskalemia- Patients with corrected dyskalemia |
Characteristic | Value (n = 424) |
---|---|
Male sex—no. (%) | 208 (49.5) |
Mean age ± SD—year | 46.3 ± 16.1 |
≥65 years—no. (%) | 47 (11.1) |
Clinical setting—no. (%) | |
Day-care patients | 333 (78.5) |
Inpatients | 91 (21.5) |
Cardiovascular treatment—no. (%) | |
ACE inhibitors/ARBs | 34 (8.0) |
Beta-blockers | 15 (3.5) |
Diuretics | 17 (4.0) |
Calcium channel blockers | 1 (0.2) |
Digoxin | 1 (0.2) |
Flecainide | 4 (0,9) |
Amiodarone | 1(0.2) |
Baseline ECG | |
Mean heart rate ± SD—beats/min | 74.6 ± 13.6 |
Mean QRS duration ± SD—ms | 82.3 ± 1646 |
Mean QTc duration ± SD—ms | 396.8 ± 29.4 |
Initial ECG patterns suggesting: | |
Long QT interval—no. (%) | 1 (0.2) |
Type I Brugada syndrome—no. (%) | 3 (0.7) |
Bundle branch block—no. (%) | 40 (9.4) |
Left ventricular hypertrophy—no. (%) | 4 (0.9) |
Pathological Q waves—no. (%) | 9 (2.1) |
Early repolarization pattern—no. (%) | 37 (8.7) |
QTc risk score Tisdale score (points), median (IQR) | 7 (6–7) |
Variable | Mean Baseline QTc ± SD—ms | Mean Day 2 QTc ± SD—ms | Mean Absolute Difference in QTc (Day 2 vs. Baseline) ± SD—ms | p-Value for Comparison of QTc between Baseline and Day 2 |
---|---|---|---|---|
General population (n = 413) | 396.0 ± 28.7 | 399.7 ± 28.7 | +3.75 ± 25.4 | 0.003 |
Sex | ||||
Female (n = 214) | 401.1 ± 27.4 | 407.0 ± 25.6 | +5.61 ± 25.3 | 0.001 |
Male (n = 199) | 390.2 ± 29 | 392.0 ± 29.8 | +1.73 ± 25.5 | 0.31 |
Age | ||||
<65 years (n = 366) | 393.7 ± 27.4 | 397.2 ± 27.8 | +3.56 ± 25.3 | 0.007 |
≥65 years (n = 47) | 413.9 ± 32.2 | 419.1 ± 27.8 | +4.62 ± 26.6 | 0.19 |
Cardiovascular disease | ||||
Absent (n = 350) | 392.2 ± 27.2 | 396.3 ± 28.0 | +4.04 ± 25.9 | 0.004 |
Present (n = 63) | 416.8 ± 27.9 | 418.9 ± 24.5 | +2.11 ± 22.7 | 0.47 |
Patient setting | ||||
Day-care (n = 328) | 391.8 ± 27.8 | 395.9 ± 27.8 | +4.11 ± 26.2 | 0.005 |
Inpatient (n = 85) | 412.3 ± 26.3 | 414.6 ± 27.4 | +2.33 ± 22.1 | 0.33 |
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Million, M.; Lagier, J.-C.; Hourdain, J.; Franceschi, F.; Deharo, J.-C.; Parola, P.; Brouqui, P. Cardiovascular Safety of Hydroxychloroquine–Azithromycin in 424 COVID-19 Patients. Medicina 2023, 59, 863. https://doi.org/10.3390/medicina59050863
Million M, Lagier J-C, Hourdain J, Franceschi F, Deharo J-C, Parola P, Brouqui P. Cardiovascular Safety of Hydroxychloroquine–Azithromycin in 424 COVID-19 Patients. Medicina. 2023; 59(5):863. https://doi.org/10.3390/medicina59050863
Chicago/Turabian StyleMillion, Matthieu, Jean-Christophe Lagier, Jérôme Hourdain, Frédéric Franceschi, Jean-Claude Deharo, Philippe Parola, and Philippe Brouqui. 2023. "Cardiovascular Safety of Hydroxychloroquine–Azithromycin in 424 COVID-19 Patients" Medicina 59, no. 5: 863. https://doi.org/10.3390/medicina59050863