ACUTE QT INTERVAL MODIFICATIONS DURING HYDROXYCHLOROQUINE-AZITHROMYCIN TREATMENT IN THE CONTEXT OF COVID-19 INFECTION.

Voisin, Olivier; Lorc’h, Erwan le; Mahé, Annabelle; Azria, Philippe; Borie, Marie-Françoise; Hubert, Sidonie; Ménage, Elodie; Guillerm, Jean-Christophe; Mourad, Jean-Jacques

Abstract Among candidate drugs to treat COVID-19, the combination of hydroxychloroquine (HCQ) and azithromycin (AZ) has received intense attention. Even if the efficacy of this combination is under evaluation, clinicians have begun to use it largely. As these medications are known to prolong QT interval, we analyzed serial electrocardiograms (ECG) performed in patients hospitalized for COVID-19 pneumonia and treated with HCQ + AZ. 50 consecutive patients received the combination of HCQ (600mg/d for 10 days) and AZ (500mg Day 1 and 250mg daily days 2 to 5). Twelve-lead ECG were performed before treatment, at Day 3, 5 and at discharge. Median age of patients was 68 years, 55.2% were males. Main comorbidities were hypertension (37%) and diabetes (17%). Mean QTc was 408 ms at baseline and rose up to 437 ms at Day 3 and to 456 ms at Day 5. 38 patients (76 %) presented short term modifications of QTc (> 30 ms). Treatment discontinuation was decided in 6 patients (12%) leading to QTc normalization in 5 of them. No death, no cardiac arrhythmic event were observed in this cohort. Our report confirms that a short duration treatment with HCQ + AZ modifies QTc interval. Treatment has to be stopped for QTc modifications in 12% of patients. Nevertheless, in inpatients hospitalized for COVID-19, we did not observe any clinically relevant consequence of these transitory modifications. In conclusion, when patients are treated with HCQ+AZ, cardiac monitoring should be regularly performed and hospital settings allow to do it in safe conditions.