Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19

Abstract

Highlights Hydroxychloroquine (HCQ) has been widely used to treat COVID-19 worldwide even without good evidence of efficacy. We analyzed the changes occurring in the QTc interval and their predictors in patients treated with HCQ-containing regimens for COVID-19. Evidence of myocardial injury with elevated troponin and strong inflammatory response, specifically higher neutrophil-to-lymphocyte ratio, were major contributors to moderate-to-severe QTc prolongation requiring careful QTc interval monitoring. In this closely screened and monitored cohort, no complications derived from QTc prolongation were observed.

Disease-drug and drug-drug interaction in COVID-19: Risk and assessment

“…These medications have been classified as having a risk of developing torsades de points (TdP). Moderate to severe QTc prolongation was observed during these pharmacological treatments [344] . The ATV-RTV has shown new options among clinically approved drugs and should be considered an effective treatment option.…”

Hydroxychloroquine, QTc prolongation and risk of torsades de pointes

“…Also in most studies, HCQ was administered to patients with severe symptoms and to patients in intensive care units, increasing the risk of indication bias. HCQ was mostly administered along with other QTc prolonging medications, particularly azithromycin [ 31 – 33 ], and in higher doses compared to the doses given in rheumatic diseases [ 34 ].…”

Systemic toxicity of chloroquine and hydroxychloroquine: prevalence, mechanisms, risk factors, prognostic and screening possibilities

“…Thus, QT prolongation is observed in 1-10% of patients under 4-AQ, as highlighted by the numerous trials conducted with these treatments in COVID-19 [69,70]. This prolongation usually appears between the 3rd and 5th day of treatment [71]. Secondary torsades de pointes are rare [72], but may occur up to several years after initiation of treatment if it is maintained [73].…”