Hydroxychloroquine and azithromycin: As a double edge sword for COVID-19?

Abstract

BackgroundHydroxychloroquine with or without azithromycin was one of the common therapies at the beginning of the COVID-19 pandemic. They can prolong QT interval, cause Torsade de pointes, and lead to sudden cardiac death. We aimed to assess QT interval prolongation and its risk factors in patients who received hydroxychloroquine with or without azithromycin.MethodsThis was a retrospective cohort study. 172 patients with COVID-19 included, hospitalized at hospitals of Babol University of Medical Sciences between March 5, 2020, and April 3, 2020. Patients were divided into two groups: hydroxychloroquine alone and hydroxychloroquine with azithromycin. Electrocardiograms were used for outcome assessment.Results83.1% of patients received hydroxychloroquine plus azithromycin vs 16.9% of patients who received only hydroxychloroquine. The mean age of patients was 59.2 ± 15.4. The mean of post-treatment QTc interval in the monotherapy group was shorter than the mean of post-treatment QTc interval in the combination therapy group but it had no significant statistical difference (462.5 ± 43.1 milliseconds vs 464.3 ± 59.1 milliseconds; P = 0.488). Generally, 22.1% of patients had a prolonged QTc interval after treatment. Male gender, or baseline QTc ≥ 450 milliseconds, or high-risk Tisdale score increased the likelihood of prolonged QTc interval. Due to QTc prolongation, 14 patients did not continue therapy after 4 days.ConclusionHospitalized patients treated with hydroxychloroquine with or without azithromycin, had no significant difference in prolongation of QT interval and outcome. But the number of patients with prolonged QT intervals in this study emphasizes careful cardiac monitoring during therapy; especially in high-risk patients.

The analysis of methylxanthine fractions obtained from Camellia sinensis cultivated in Turkey and effects on the in vitro inhibition of CYP2D6 enzyme

“…Quinidine is the most popular subject of the reports on the QT interval prolonging agents and antimalarial drugs 29 . Its chemical structure and function is identical to hydroxychloroquine, which causes an increase of plasma exposure of beta‐blockers that are metabolized to varied rates by CYP2D6 30 .…”

“…Quinidine is the most popular subject of the reports on the QT interval prolonging agents and antimalarial drugs. 29 Its chemical structure and function is identical to hydroxychloroquine, which causes an increase of plasma exposure of beta-blockers that are metabolized to varied rates by CYP2D6. 30 It was reported that hydroxychloroquine effectively inhibited SARS-CoV-2 infection in vitro and have indicated clinical and virologic advantages in COVID-19 patients.…”

Burden of Proof: Lessons Learned for Regulators from the Oversight Board’s Implementation Work

“…For example, in the Claimed COVID-19 cure case heard in 2021, the Board recommended that Meta publish a transparency report on how the company's Community Standards have been enforced during the COVID-19 pandemic (OSB 2021c). In its initial response to the recommendation, Meta stated that it will "continue to look for ways to communicate the efficacy of our efforts to combat COVID-19 misinformation" (Meta 2021a). Meta's response reframes the recommendation to be about its enforcement on COVID-19-related content, whereas the Board's initial recommendation asked Meta to disclose information about its enforcement generally during the COVID-19 pandemic.…”