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Systematic Review

Effect of Hydroxychloroquine on QTc in Patients Diagnosed with COVID-19: A Systematic Review and Meta-Analysis

by
Angelos Arfaras-Melainis
1,*,
Andreas Tzoumas
2,
Damianos G. Kokkinidis
3,
Maria Salgado Guerrero
1,
Dimitrios Varrias
1,
Xiaobo Xu
1,
Luis Cerna
4,
Ricardo Avendano
3,
Cameron Kemal
5,
Leonidas Palaiodimos
1 and
Robert T. Faillace
1
1
Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
2
School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
3
Section of Cardiovascular Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT 06510, USA
4
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
5
Leon H. Charney Division of Cardiology, New York University, New York, NY 10016, USA
*
Author to whom correspondence should be addressed.
J. Cardiovasc. Dev. Dis. 2021, 8(5), 55; https://doi.org/10.3390/jcdd8050055
Submission received: 20 March 2021 / Revised: 25 April 2021 / Accepted: 8 May 2021 / Published: 13 May 2021
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Abstract

Background: Hydroxychloroquine or chloroquine with or without the concomitant use of azithromycin have been widely used to treat patients with SARS-CoV-2 infection, based on early in vitro studies, despite their potential to prolong the QTc interval of patients. Objective: This is a systematic review and metanalysis designed to assess the effect of hydroxychloroquine with or without the addition of azithromycin on the QTc of hospitalized patients with COVID-19. Materials and methods: PubMed, Scopus, Cochrane and MedRxiv databases were reviewed. A random effect model meta-analysis was used, and I-square was used to assess the heterogeneity. The prespecified endpoints were ΔQTc, QTc prolongation > 500 ms and ΔQTc > 60 ms. Results: A total of 18 studies and 7179 patients met the inclusion criteria and were included in this systematic review and meta-analysis. The use of hydroxychloroquine with or without the addition of azithromycin was associated with increased QTc when used as part of the management of patients with SARS-CoV-2 infection. The combination therapy with hydroxychloroquine plus azithromycin was also associated with statistically significant increases in QTc. Moreover, the use of hydroxychloroquine alone, azithromycin alone, or the combination of the two was associated with increased numbers of patients that developed QTc prolongation > 500 ms. Conclusion: This systematic review and metanalysis revealed that the use of hydroxychloroquine alone or in conjunction with azithromycin was linked to an increase in the QTc interval of hospitalized patients with SARS-CoV-2 infection that received these agents.
Keywords: hydroxychloroquine; chloroquine; COVID-19; coronavirus; SARS-CoV-2; QTc; QTc prolongation; torsades de pointes hydroxychloroquine; chloroquine; COVID-19; coronavirus; SARS-CoV-2; QTc; QTc prolongation; torsades de pointes

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MDPI and ACS Style

Arfaras-Melainis, A.; Tzoumas, A.; Kokkinidis, D.G.; Salgado Guerrero, M.; Varrias, D.; Xu, X.; Cerna, L.; Avendano, R.; Kemal, C.; Palaiodimos, L.; et al. Effect of Hydroxychloroquine on QTc in Patients Diagnosed with COVID-19: A Systematic Review and Meta-Analysis. J. Cardiovasc. Dev. Dis. 2021, 8, 55. https://doi.org/10.3390/jcdd8050055

AMA Style

Arfaras-Melainis A, Tzoumas A, Kokkinidis DG, Salgado Guerrero M, Varrias D, Xu X, Cerna L, Avendano R, Kemal C, Palaiodimos L, et al. Effect of Hydroxychloroquine on QTc in Patients Diagnosed with COVID-19: A Systematic Review and Meta-Analysis. Journal of Cardiovascular Development and Disease. 2021; 8(5):55. https://doi.org/10.3390/jcdd8050055

Chicago/Turabian Style

Arfaras-Melainis, Angelos, Andreas Tzoumas, Damianos G. Kokkinidis, Maria Salgado Guerrero, Dimitrios Varrias, Xiaobo Xu, Luis Cerna, Ricardo Avendano, Cameron Kemal, Leonidas Palaiodimos, and et al. 2021. "Effect of Hydroxychloroquine on QTc in Patients Diagnosed with COVID-19: A Systematic Review and Meta-Analysis" Journal of Cardiovascular Development and Disease 8, no. 5: 55. https://doi.org/10.3390/jcdd8050055

APA Style

Arfaras-Melainis, A., Tzoumas, A., Kokkinidis, D. G., Salgado Guerrero, M., Varrias, D., Xu, X., Cerna, L., Avendano, R., Kemal, C., Palaiodimos, L., & Faillace, R. T. (2021). Effect of Hydroxychloroquine on QTc in Patients Diagnosed with COVID-19: A Systematic Review and Meta-Analysis. Journal of Cardiovascular Development and Disease, 8(5), 55. https://doi.org/10.3390/jcdd8050055

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