Effect of hydroxychloroquine, azithromycin and lopinavir/ritonavir on the QT corrected interval in patients with COVID-19

• Published in: Journal of electrocardiology Vol. 64; pp. 30 - 35
• Main Authors: Echarte-Morales, Julio, Minguito-Carazo, Carlos, del Castillo-García, Samuel, Borrego-Rodríguez, Javier, Rodríguez-Santamarta, Miguel, Sánchez-Muñoz, Enrique, Bergel-García, Rubén, González-Maniega, Clea, Prieto-González, Silvia, Menéndez-Suarez, Paula, Tundidor-Sanz, Elena, Benito-González, Tomás, Fernández-Vázquez, Felipe
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2021; Elsevier Science Ltd
• Subjects: Aged; Anti-Infective Agents - pharmacology; Anti-Infective Agents - therapeutic use; Antibiotics; Antiretroviral drugs; Antiviral drugs; Azithromycin; Azithromycin - pharmacology; Azithromycin - therapeutic use; COVID-19; COVID-19 - drug therapy; COVID-19 - physiopathology; Drug therapy; Drug Therapy, Combination; Electrocardiography - drug effects; Female; HIV Protease Inhibitors - pharmacology; HIV Protease Inhibitors - therapeutic use; Humans; Hydroxychloroquine; Hydroxychloroquine - pharmacology; Hydroxychloroquine - therapeutic use; Kaplan-Meier Estimate; Lopinavir - pharmacology; Lopinavir - therapeutic use; Lopinavir/ritonavir; Male; Middle Aged; Pandemics; Prospective Studies; QT corrected interval; Ritonavir - pharmacology; Ritonavir - therapeutic use; COVID-19; DT; TT; QTc; QT corrected interval; Hydroxychloroquine; Lopinavir/ritonavir; SCD; Azithromycin; VA
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2020.11.012

Administration 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. Our 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. Patients 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. 168 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. DT 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. •What is known?.•Hydroxychloroquine and Azithromycin prolong QTc in patients with COVID-19 prompting ECG monitoring.•What is the new?•In our series, the addition of Lopinavir/ritonavir to Hydroxychloroquine and Azithromycindid not further prolong QTc interval compared to double therapy.