Electrocardiographic safety of daily Hydroxychloroquine 400mg plus Azithromycin 250mg as an ambulatory treatment for COVID-19 patients in Cameroon
Liliane Mfeukeu-Kuate, MD; William Ngatchou, Mazou Ngou Temgoua, MD Charles Kouanfack, PhD Daniel Lemogoum, Joel Noutakdie Tochie, MD Armel Zemsi, MD Lauriane Fomete, MD; Skinner Skinner Lekelem, MD; Sylvain Sylvain Zemsi, BSc Joelle Sobngwi, PhD Thierry Ntandzi, Christian Ngongang Ouankou, MD Yves Wasnyo, MD, MPH Antoinette Ntsama Assiga, Jan René Nkeck, Ahmadou Musa Jingi, MD Magellan Guewo, Eric Walter Pefura Yone, Charlotte Moussi Omgba, MD, MPH Paul Owono Etoundi, Jean Cyr Yombi, MD Alain Menanga, MD Samuel Kingue, Jacqueline Ze Minkande, MD; Jean Claude Mbanya, PhD Pierre Ongolo Zogo, Pierre Joseph Fouda, MD Eugène Sobngwi
doi:10.1101/2020.06.24.20139386
Objective : To determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychloroquine and Azithromycin. Design : Prospective study. Setting : Treatment centres of the city of Yaounde, Cameroon, from May 7th to 24th 2020. Participants : We enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200mg twice daily during seven days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard. Main outcomes measures : The primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the course of treatment. Results: The population (29 men and 22 women) was aged 39 ± 11 years (range 17 to 61 years). Mean Tisdale score was 3.35±0.48. No significant change from baseline (D0) of QTc was observed at D7 (429±27 ms at D0 versus 396±26 ms at D7; p=0.27). A reduction of heart rate was observed between the D0 and D7 (75±13 bpm versus 70±13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95±10 ms versus 102±17 ms, p = 0.004). No symptomatic arrhythmic events occurred during the treatment course. Conclusions: No life-threatening modifications of the QT interval was observed in nonsevere COVID-19 patients treated ambulatory with hydroxychloroquine and azithromycin. Studies are needed in critical-ill and older patients.
References
Acc, Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment For COVID-19
Akhmerov, Marbán, COVID-19 and the Heart, Circulation Research
Chorin, Wadhwani, Magnani, QT Interval Prolongation and Torsade De Pointes in Patients with COVID-19 treated with Hydroxychloroquine/Azithromycin, Heart Rhythm
Ecdc, COVID-19 situation update worldwide, as of 22
Guzik, Mohiddin, Dimarco, COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options, Cardiovascular Research,
doi:10.1093/cvr/cvaa106/5826160Hegarty, Why Bazett 's Formula? Anesthesia & Analgesia
Liu, Cao, Xu, Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro, Cell Discovery
Mercuro, Yen, Shim, Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease, JAMA Cardiology
Olano, Howland, Su, Toxicokinetics of hydroxychloroquine following a massive overdose, The American Journal of Emergency Medicine
Rosenberg, Dufor, Udo, Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID_19 in New York State, JAMA
Saleh, Gabriels, Chang, The Effect of Chloroquine, Hydroxychloroquine and Azithromycin on the Corrected QT Interval in Patients with SARS-CoV-2 Infection, Circulation: Arrhythmia and Electrophysiology,
doi:10.1161/CIRCEP.120.008662Tisdale, Jaynes, Kingery, Development and validation of a risk score to predict QT interval prolongation in hospitalized patients, Circ Cardiovasc Qual Outcomes
Varga, Flammer, Steiger, Endothelial cell infection and endotheliitis in COVID-19, The Lancet
Who, Coronavirus disease
