The impact of hydroxychloroquine and azithromycin on the corrected qt interval in patients with the novel coronavirus disease 2019

Funding Acknowledgements Type of funding sources: None. Background Although long-term use of HCQ and AZT has been reported to cause QT prolongation and malign arrhythmia, there is not enough data about the effect of short-term use on arrhythmia. Purpose: The aim of this study was to assess the effect of HCQ alone and HCQ + AZT on corrected QT (QTc).Methods: A baseline ECG and on-treatment ECGs were retrospectively collected in COVID-19 patients who received HCQ and/or AZT. Also peak QTc intervals of monotherapy and combination therapy was compared. Results: Of the 155 patients included, 102 (65.8%) were using HCQ, 53 (34.2%) were using HCQ + AZT combination. The use of both HCQ alone and HCQ + AZT combined therapy significantly prolonged the QTc and the QTc interval was significantly longer in patients received combination therapy. QTc prolongation caused early termination in both groups, 5 (4.9%) patients in the monotherapy group and in 6 (11.3%) patients in the combined therapy group.Conclusion: Patients who received HCQ for COVID-19 were at high risk of QTc prolongation, and concurrent treatment with AZT was associated with greater changes in QTc. Comparison of baseline characteristics a Characteristic Total (n = 155) Hydroxychloroquine (n = 102) Hydroxychloroquine /Azithromycin (n = 53) P value Length of stay at ward, SD 9.54 ± 4.28 9.64 ± 4.31 9.31 ± 4.25 0.88 Length of stay Intensive care unite,SD 7.92 ± 3.76 7.18 ± 3.18 8.46 ± 4.15 0.29 Radiographic findings of pneumonia 118(76.1%) 76(74.5%) 42(49.2%) 0.32 Mechanically ventilation 16(10.3%) 7(6.9%) 9(17.0%) 0.049 In hospital death 19(12.3%) 10(9.8%) 9(17.0%) 0.15 ECG findings median(IQR) (ms) Baseline QRS duration 91.0(80.0-103.0) 92.5(80.75-105.50) 90.0(80.0-102.5) 0.5 Posttreatment QRS peak 97.0(86.0-109.0) 97.5(88.0-109.25) 95.0(85.5-109) 0.68 ΔQRS 4.0(0.0-9.0) 2.0(0.0-8.25) 5.0(1.0-9.5) 0.14 Baseline QTc duration 407.0(385.0-426.0) 408.0(389.25-427.50) 404.0(384.0-420.0) 0.1 Posttreatment QTc peak 437.0(414.0-460.0) 428.0(412.75-449.25) 456.0(422.0-467.5) <0.001 ΔQTc 27.0(13.0-45.0) 18.0(11.0-30.0) 46.0(40.5-54.5) <0.001 Baseline PR duration 145.50(128.7-160.0) 147.0(135.0-160.0) 144.0(120.0-160.0) 0.53 Posttreatment PR peak 159.0(140.0-170.0) 159.0(141.0-168.50) 156.0(139.5-171.0) 0.97 ΔPR 7.0(1.0-13.0) 5.0(0.0-12.25) 10.0(5.0-15.0) 0.022 QTc peak day 5.0(4.0-5.0) 5.0(4.0-6.0) 4.0(3.0-5.0) 0.022 Drug withdrawl due to QRS prolongation 11(7.1%) 5(4.9%) 6(11.3%) 0.12