Use of COVID-19 antimalarial drugs associated with increased risk of cardiac arrhythmias

Reviewed by Emily Henderson, B.Sc.May 3, 2020

Since the World Health Organization declared COVID-19 a public health concern of global concern on 30 January, more than 1 million people have tested positive for the disease in the United States and more than 62,000 people have died. I am. With no FDA-approved treatment to date, the antimalarial hydroxychloroquine, with or without the antibiotic azithromycin, has emerged as a potential treatment for COVID-19-related pneumonia.

In a brief report released today JAMA Cardiology, A team of pharmacists and clinicians at the Beth Israel Deaconess Medical Center (BIDMC), which is part of Beth Israel Rahealth, said We have found evidence to suggest a high risk. The combination of hydroxychloroquine and azithromycin was associated with even greater changes compared to hydroxychloroquine alone.

Hydroxychloroquine and azithromycin are generally well-tolerated drugs, but increased use in the context of COVID-19 may increase the frequency of adverse drug events (ADE). This is of particular concern given that patients with the underlying cardiac comorbidity appear to be overly affected by COVID-19, and the virus itself can damage the heart. “

Nicholas J. Mercuro, PharmD, Co-author, Infectious Disease Pharmacy Specialist at BIDMC

Hydroxychloroquine and azithromycin, respectively, can cause electrical damage to the heart known as QTc prolongation, indicated by the longer space between specific peaks on the electrocardiogram. The prolongation of QTc indicates that the heart beat takes a few milliseconds longer than usual to recharge. Delays can cause cardiac arrhythmias, which in turn increase the likelihood of cardiac arrest, stroke or death.

In this single-center, retrospective observational study, Mercuro et al. Found that adults with COVID-19 who were admitted to BIDMC between March 1 and April 7, 2020 and received hydroxychloroquine for at least 1 day 90 Evaluated people Over half of these patients had high blood pressure and over 30% had diabetes.

Seven patients (19%) who received only hydroxychloroquine showed a QTc prolongation of ≥500 ms and 3 patients had a QTc change of ≥60 ms. Of the 53 patients who also received azithromycin, 21% had a QTc prolongation of ≥500 ms and 13% experienced changes in QTc of ≥60 ms.

In our study, hospitalized patients receiving COVID-19 hydroxychloroquine frequently experienced QTc prolongation and adverse drug events. One participant taking the drug combination experienced a potentially fatal tachycardia called torsades de pointes.

Christina F. Yen, MD, co-lead author of the BIDMC School of Medicine

Preliminary 2003 data suggest that hydroxychloroquine may be effective against SARS-CoV-1, a deadly but less contagious respiratory virus associated with the coronavirus that causes COVID-19. Has been suggested. Most recently, a small study of COVID-19 patients has shown that antimalarial drugs may be beneficial. However, subsequent studies have not confirmed either finding. In light of their data, Gold and colleagues urge caution and careful consideration before administering hydroxychloroquine as a treatment for COVID-19.

“Clinicians should carefully weigh the risks and benefits, especially when considering the use of hydroxychloroquine in combination with azithromycin, and closely monitor QTc, especially in consideration of patient comorbidities and concomitant drug use.” Yes, ”said senior author Howard S. Gold. , BIDMC infectious disease specialist, Associate Professor of Harvard Medical School. “Based on our current knowledge, hydroxychloroquine for the treatment of COVID-19 should probably be limited to clinical trials.”