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Observational Study
Effect of hydroxychloroquine, azithromycin and lopinavir/ritonavir on the QT corrected interval in patients with COVID-19.
- Julio Echarte-Morales, Carlos Minguito-Carazo, Samuel Del Castillo-García, Javier Borrego-Rodríguez, Miguel Rodríguez-Santamarta, Enrique Sánchez-Muñoz, Rubén Bergel-García, Clea González-Maniega, Silvia Prieto-González, Paula Menéndez-Suarez, Elena Tundidor-Sanz, Tomás Benito-González, and Felipe Fernández-Vázquez.
- Department of Cardiology, University Hospital of León, León, Spain.
- J Electrocardiol. 2021 Jan 1; 64: 30-35.
BackgroundAdministration of Hydroxychloroquine and Azithromycin in patients with coronavirus disease 2019 (COVID-19) prolongs QTc corrected interval (QTc). The effect and safety of Lopinavir/Ritonavir in combination with these therapies have seldom been studied.ObjectivesOur aim was to evaluate changes in QTc in patients receiving double (Hydroxychloroquine + Azithromycin) and triple therapy (Hydroxychloroquine + Azithromycin + Lopinavir/Ritonavir) to treat COVID-19. Secondary outcome was the incidence of in-hospital all-cause mortality.MethodsPatients under treatment with double (DT) and triple therapy (TT) for COVID-19 were consecutively included in this prospective observational study. Serial in-hospital electrocardiograms were performed to measure QTc at baseline and during therapy.Results168 patients (±66.2 years old) were included: 32.1% received DT and 67.9% received TT. The mean baseline QTc was 410.33 ms. Patients under DT and TT prolonged QTc interval respect baseline values (p < 0.001), without significant differences between both therapy groups (p = 0.748). Overall, 33 patients (19.6%) had a peak QTc and/or an increase QTc 60 ms from baseline, with a higher prevalence among those with hypokalemia (p = 0.003). All-cause mortality was similar between both strategy groups (p = 0.093) and high risk QTc prolongation was no related to clinical events in this series.ConclusionsDT and TT prolong the QTc in patients with COVID-19. Addition of Lopinavir/Ritonavir on top of Hydroxychloroquine and Azithromycin did not increase QTc compared to DT.Copyright © 2020 Elsevier Inc. All rights reserved.
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