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Assessment of QT Intervals in a Case Series of Patients With Coronavirus Disease 2019 (COVID-19) Infection Treated With Hydroxychloroquine Alone or in Combination With Azithromycin in an Intensive Care Unit

Educational Objective
To understand the safety concerns of prescribing hydroxychloroquine without azithromycin
1 Credit CME

The novel coronavirus disease 2019 (COVID-19) outbreak is an ongoing situation caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 Studies in patients with mild to moderate COVID-19 symptoms have suggested benefits of hydroxychloroquine alone or in combination with azithromycin against SARS-CoV-2 and raised hope for treating the disease.2 As a result, these treatments are increasingly used off-label for patients with COVID-19, including for those in intensive care units (ICUs).2,3 However, both medications are known to induce QT prolongation via a human Ether-à-go-go–related gene potassium channel blockade, which can promote life-threatening ventricular arrhythmias.4,5 Safety data for these treatments are largely lacking for patients with COVID-19. This is even more relevant for critically ill patients who are particularly exposed to electrolyte imbalance and/or drugs leading to an increased risk of QT prolongation.6 Therefore, we aimed to examine the safety of hydroxychloroquine with or without azithromycin regarding QT interval in ICU patients with COVID-19.

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Article Information

Accepted for Publication: April 14, 2020

Corresponding Author: Martin Cour, MD, PhD, Médecine Intensive-Réanimation, Hôpital Edouard Herriot, 5, Place d’Arsonval, 69437 Lyon Cedex 03, France (martin.cour@chu-lyon.fr).

Author Contributions: Drs Bessière and Cour had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Bessiere, Roccia, Chevalier, Argaud, Cour.

Acquisition, analysis, or interpretation of data: Bessiere, Roccia, Deliniere, Charriere, Chevalier, Cour.

Drafting of the manuscript: Bessiere, Roccia, Chevalier, Cour.

Critical revision of the manuscript for important intellectual content: Bessiere, Roccia, Deliniere, Charriere, Argaud, Cour.

Statistical analysis: Bessiere, Cour.

Supervision: Bessiere, Deliniere, Chevalier, Argaud, Cour.

Conflict of Interest Disclosures: Dr Bessière reports grants and personal fees from Abbott, Boston Scientific, Medtronic, Biosense, and Volta Medical outside the submitted work. Dr Chevalier reports grants from Abbott, Boston Scientific, and Medtronic outside the submitted work. No other disclosures were reported.

Published Online: May 1, 2020. doi:10.1001/jamacardio.2020.1787

Correction: This article was corrected on June 24, 2020, to fix errors in the Conflict of Interest Disclosures.

Additional Contributions: We thank Verena Landel, DRCI, Hospices Civils de Lyon, for her help in manuscript preparation. She was not compensated for her contributions.

References
1.
Wu  Z , McGoogan  JM .  Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.   JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648PubMedGoogle Scholar
2.
Kupferschmidt  K , Cohen  J .  Race to find COVID-19 treatments accelerates.   Science. 2020;367(6485):1412-1413. doi:10.1126/science.367.6485.1412PubMedGoogle ScholarCrossref
3.
Mahase  E .  Covid-19: six million doses of hydroxychloroquine donated to US despite lack of evidence.   BMJ. 2020;368:m1166. doi:10.1136/bmj.m1166PubMedGoogle ScholarCrossref
4.
Drew  BJ , Ackerman  MJ , Funk  M ,  et al; American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the American College of Cardiology Foundation.  Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation.   Circulation. 2010;121(8):1047-1060. doi:10.1161/CIRCULATIONAHA.109.192704PubMedGoogle ScholarCrossref
5.
Yazdany  J , Kim  AHJ .  Use of Hydroxychloroquine and chloroquine during the COVID-19 pandemic: what every clinician should know.   Ann Intern Med. Published online March 31, 2020. doi:10.7326/M20-1334PubMedGoogle Scholar
6.
Etchegoyen  CV , Keller  GA , Mrad  S , Cheng  S , Di Girolamo  G .  Drug-induced QT interval prolongation in the intensive care unit.   Curr Clin Pharmacol. 2017;12(4):210-222. doi:10.2174/1574884713666180223123947PubMedGoogle ScholarCrossref
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