Effect of Triple Combination Therapy With Lopinavir-Ritonavir, Azithromycin, and Hydroxychloroquine on QT Interval and Arrhythmic Risk in Hospitalized COVID-19 Patients

• Main Authors: Vincenzo Russo (Author), Andreina Carbone (Author), Filiberto Fausto Mottola (Author), Rosa Mocerino (Author), Raffaele Verde (Author), Emilio Attena (Author), Nicoletta Verde (Author), Pierpaolo Di Micco (Author), Luigi Nunziata (Author), Francesco Santelli (Author), Gerardo Nigro (Author), Sergio Severino (Author)
• Format: Book
• Published: Frontiers Media S.A., 2020-10-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

IntroductionNo data are provided about the effect of triple combination therapy with Lopinavir/Ritonavir (LPN/RTN), hydroxychloroquine (HQ) and azithromycin (AZT) on corrected QT (QTc) interval and arrhythmic risk, in COVID-19 patients. This study aims to describe the incidence of extreme QTc interval prolongation among COVID-19 patients on this experimental treatment and to identify the clinical features associated with extreme QTc prolongation.Materials and MethodsData of 87 COVID-19 patients, treated with triple combination including LPN/RTN, HQ and AZT, were analyzed. QT interval was obtained by the tangent method and corrected for heart rate using Bazett's formula. Extreme QTc interval prolongation was considered an absolute QTc interval ≥ 500 ms or an increase in QTc intervals of 60 ms or greater (ΔQTc ≥ 60 ms) compared with baseline.ResultsHypertension (66.7%) and diabetes (25.3%) were the most prevalent cardiovascular comorbidities. Twenty patients (23%) showed extreme QTc interval prolongation; no clinical, electrocardiographic or pharmacological characteristics have been associated to extreme QTc prolongation, except the history of ischemic stroke (P= 0,007). One torsade de pointes (TdP) in patient with QTc extreme prolongation (QTc: 560 ms) after 5 days of therapy was recorded.ConclusionsWe observed a high incidence of extreme QTc interval prolongation among COVID-19 patients on triple combination therapy. Since the incidence of malignant arrhythmias seems to be not negligible, a careful electrocardiographic monitoring would be advisable.

Item Description

1663-9812
10.3389/fphar.2020.582348