Cardiac Toxicity of Chloroquine or Hydroxychloroquine in Patients With COVID-19: A Systematic Review and Meta-regression Analysis.
Identifieur interne : 000873 ( Main/Corpus ); précédent : 000872; suivant : 000874Cardiac Toxicity of Chloroquine or Hydroxychloroquine in Patients With COVID-19: A Systematic Review and Meta-regression Analysis.
Auteurs : Imad M. Tleyjeh ; Zakariya Kashour ; Oweida Aldosary ; Muhammad Riaz ; Haytham Tlayjeh ; Musa A. Garbati ; Rana Tleyjeh ; Mouaz H. Al-Mallah ; M Rizwan Sohail ; Dana Gerberi ; Aref A. Bin Abdulhak ; John R. Giudicessi ; Michael J. Ackerman ; Tarek KashourSource :
- Mayo Clinic proceedings. Innovations, quality & outcomes [ 2542-4548 ] ; 2021.
Abstract
Objective
To systematically review the literature and to estimate the risk of chloroquine (CQ) and hydroxychloroquine (HCQ) cardiac toxicity in patients with coronavirus disease 2019 (COVID-19).
Methods
We searched multiple data sources including PubMed/MEDLINE, Ovid Embase, Ovid EBM Reviews, Scopus, and Web of Science and medrxiv.org from November 2019 through May 27, 2020. We included studies that enrolled patients with COVID-19 treated with CQ or HCQ, with or without azithromycin, and reported on cardiac toxic effects. We performed a meta-analysis using the arcsine transformation of the different incidences.
Results
A total of 19 studies with a total of 5652 patients were included. The pooled incidence of torsades de pointes arrhythmia, ventricular tachycardia, or cardiac arrest was 3 per 1000 (95% CI, 0-21;
Conclusion
Treatment of patients with COVID-19 with CQ or HCQ is associated with an important risk of drug-induced QT prolongation and relatively higher incidence of torsades de pointes, ventricular tachycardia, or cardiac arrest. Therefore, these agents should not be used routinely in the management of COVID-19 disease. Patients with COVID-19 who are treated with antimalarials for other indications should be adequately monitored.
DOI: 10.1016/j.mayocpiqo.2020.10.005
PubMed: 33163895
PubMed Central: PMC7605861
Links to Exploration step
pubmed:33163895Le document en format XML
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<affiliation><nlm:affiliation>College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.</nlm:affiliation>
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<author><name sortKey="Riaz, Muhammad" sort="Riaz, Muhammad" uniqKey="Riaz M" first="Muhammad" last="Riaz">Muhammad Riaz</name>
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<author><name sortKey="Tlayjeh, Haytham" sort="Tlayjeh, Haytham" uniqKey="Tlayjeh H" first="Haytham" last="Tlayjeh">Haytham Tlayjeh</name>
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<author><name sortKey="Al Mallah, Mouaz H" sort="Al Mallah, Mouaz H" uniqKey="Al Mallah M" first="Mouaz H" last="Al-Mallah">Mouaz H. Al-Mallah</name>
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<author><name sortKey="Sohail, M Rizwan" sort="Sohail, M Rizwan" uniqKey="Sohail M" first="M Rizwan" last="Sohail">M Rizwan Sohail</name>
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<affiliation><nlm:affiliation>Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
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<author><name sortKey="Gerberi, Dana" sort="Gerberi, Dana" uniqKey="Gerberi D" first="Dana" last="Gerberi">Dana Gerberi</name>
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<author><name sortKey="Bin Abdulhak, Aref A" sort="Bin Abdulhak, Aref A" uniqKey="Bin Abdulhak A" first="Aref A" last="Bin Abdulhak">Aref A. Bin Abdulhak</name>
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<author><name sortKey="Giudicessi, John R" sort="Giudicessi, John R" uniqKey="Giudicessi J" first="John R" last="Giudicessi">John R. Giudicessi</name>
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</affiliation>
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<author><name sortKey="Ackerman, Michael J" sort="Ackerman, Michael J" uniqKey="Ackerman M" first="Michael J" last="Ackerman">Michael J. Ackerman</name>
<affiliation><nlm:affiliation>Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Kashour, Tarek" sort="Kashour, Tarek" uniqKey="Kashour T" first="Tarek" last="Kashour">Tarek Kashour</name>
<affiliation><nlm:affiliation>Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia.</nlm:affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Cardiac Toxicity of Chloroquine or Hydroxychloroquine in Patients With COVID-19: A Systematic Review and Meta-regression Analysis.</title>
<author><name sortKey="Tleyjeh, Imad M" sort="Tleyjeh, Imad M" uniqKey="Tleyjeh I" first="Imad M" last="Tleyjeh">Imad M. Tleyjeh</name>
<affiliation><nlm:affiliation>Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Kashour, Zakariya" sort="Kashour, Zakariya" uniqKey="Kashour Z" first="Zakariya" last="Kashour">Zakariya Kashour</name>
<affiliation><nlm:affiliation>Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Aldosary, Oweida" sort="Aldosary, Oweida" uniqKey="Aldosary O" first="Oweida" last="Aldosary">Oweida Aldosary</name>
<affiliation><nlm:affiliation>Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Riaz, Muhammad" sort="Riaz, Muhammad" uniqKey="Riaz M" first="Muhammad" last="Riaz">Muhammad Riaz</name>
<affiliation><nlm:affiliation>Department of Statistics, Quaid Azam University Islamabad, Pakistan.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Tlayjeh, Haytham" sort="Tlayjeh, Haytham" uniqKey="Tlayjeh H" first="Haytham" last="Tlayjeh">Haytham Tlayjeh</name>
<affiliation><nlm:affiliation>Department of Intensive Care, King Abdulaziz Medical City, King Saud bin Abdulaziz for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Garbati, Musa A" sort="Garbati, Musa A" uniqKey="Garbati M" first="Musa A" last="Garbati">Musa A. Garbati</name>
<affiliation><nlm:affiliation>Infectious Diseases Unit, Department of Medicine, University of Maiduguri, Maiduguri, Nigeria.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Tleyjeh, Rana" sort="Tleyjeh, Rana" uniqKey="Tleyjeh R" first="Rana" last="Tleyjeh">Rana Tleyjeh</name>
<affiliation><nlm:affiliation>College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Al Mallah, Mouaz H" sort="Al Mallah, Mouaz H" uniqKey="Al Mallah M" first="Mouaz H" last="Al-Mallah">Mouaz H. Al-Mallah</name>
<affiliation><nlm:affiliation>Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Sohail, M Rizwan" sort="Sohail, M Rizwan" uniqKey="Sohail M" first="M Rizwan" last="Sohail">M Rizwan Sohail</name>
<affiliation><nlm:affiliation>Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Gerberi, Dana" sort="Gerberi, Dana" uniqKey="Gerberi D" first="Dana" last="Gerberi">Dana Gerberi</name>
<affiliation><nlm:affiliation>Mayo Clinic Libraries, Mayo Clinic, Rochester, MN.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Bin Abdulhak, Aref A" sort="Bin Abdulhak, Aref A" uniqKey="Bin Abdulhak A" first="Aref A" last="Bin Abdulhak">Aref A. Bin Abdulhak</name>
<affiliation><nlm:affiliation>Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Giudicessi, John R" sort="Giudicessi, John R" uniqKey="Giudicessi J" first="John R" last="Giudicessi">John R. Giudicessi</name>
<affiliation><nlm:affiliation>Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Ackerman, Michael J" sort="Ackerman, Michael J" uniqKey="Ackerman M" first="Michael J" last="Ackerman">Michael J. Ackerman</name>
<affiliation><nlm:affiliation>Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Kashour, Tarek" sort="Kashour, Tarek" uniqKey="Kashour T" first="Tarek" last="Kashour">Tarek Kashour</name>
<affiliation><nlm:affiliation>Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia.</nlm:affiliation>
</affiliation>
</author>
</analytic>
<series><title level="j">Mayo Clinic proceedings. Innovations, quality & outcomes</title>
<idno type="eISSN">2542-4548</idno>
<imprint><date when="2021" type="published">2021</date>
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<front><div type="abstract" xml:lang="en"><p><b>Objective</b>
</p>
<p>To systematically review the literature and to estimate the risk of chloroquine (CQ) and hydroxychloroquine (HCQ) cardiac toxicity in patients with coronavirus disease 2019 (COVID-19).</p>
</div>
<div type="abstract" xml:lang="en"><p><b>Methods</b>
</p>
<p>We searched multiple data sources including PubMed/MEDLINE, Ovid Embase, Ovid EBM Reviews, Scopus, and Web of Science and medrxiv.org from November 2019 through May 27, 2020. We included studies that enrolled patients with COVID-19 treated with CQ or HCQ, with or without azithromycin, and reported on cardiac toxic effects. We performed a meta-analysis using the arcsine transformation of the different incidences.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>Results</b>
</p>
<p>A total of 19 studies with a total of 5652 patients were included. The pooled incidence of torsades de pointes arrhythmia, ventricular tachycardia, or cardiac arrest was 3 per 1000 (95% CI, 0-21; </p>
</div>
<div type="abstract" xml:lang="en"><p><b>Conclusion</b>
</p>
<p>Treatment of patients with COVID-19 with CQ or HCQ is associated with an important risk of drug-induced QT prolongation and relatively higher incidence of torsades de pointes, ventricular tachycardia, or cardiac arrest. Therefore, these agents should not be used routinely in the management of COVID-19 disease. Patients with COVID-19 who are treated with antimalarials for other indications should be adequately monitored.</p>
</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">33163895</PMID>
<DateRevised><Year>2021</Year>
<Month>03</Month>
<Day>04</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2542-4548</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>5</Volume>
<Issue>1</Issue>
<PubDate><Year>2021</Year>
<Month>Feb</Month>
</PubDate>
</JournalIssue>
<Title>Mayo Clinic proceedings. Innovations, quality & outcomes</Title>
<ISOAbbreviation>Mayo Clin Proc Innov Qual Outcomes</ISOAbbreviation>
</Journal>
<ArticleTitle>Cardiac Toxicity of Chloroquine or Hydroxychloroquine in Patients With COVID-19: A Systematic Review and Meta-regression Analysis.</ArticleTitle>
<Pagination><MedlinePgn>137-150</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1016/j.mayocpiqo.2020.10.005</ELocationID>
<Abstract><AbstractText Label="Objective" NlmCategory="UNASSIGNED">To systematically review the literature and to estimate the risk of chloroquine (CQ) and hydroxychloroquine (HCQ) cardiac toxicity in patients with coronavirus disease 2019 (COVID-19).</AbstractText>
<AbstractText Label="Methods" NlmCategory="UNASSIGNED">We searched multiple data sources including PubMed/MEDLINE, Ovid Embase, Ovid EBM Reviews, Scopus, and Web of Science and medrxiv.org from November 2019 through May 27, 2020. We included studies that enrolled patients with COVID-19 treated with CQ or HCQ, with or without azithromycin, and reported on cardiac toxic effects. We performed a meta-analysis using the arcsine transformation of the different incidences.</AbstractText>
<AbstractText Label="Results" NlmCategory="UNASSIGNED">A total of 19 studies with a total of 5652 patients were included. The pooled incidence of torsades de pointes arrhythmia, ventricular tachycardia, or cardiac arrest was 3 per 1000 (95% CI, 0-21; <i>I</i>
<sup><i>2</i>
</sup>
=96%) in 18 studies with 3725 patients. Among 13 studies of 4334 patients, the pooled incidence of discontinuation of CQ or HCQ due to prolonged QTc or arrhythmias was 5% (95% CI, 1-11; <i>I</i>
<sup><i>2</i>
</sup>
=98%). The pooled incidence of change in QTc from baseline of 60 milliseconds or more or QTc of 500 milliseconds or more was 9% (95% CI, 3-17; <i>I</i>
<sup><i>2</i>
</sup>
=97%). Mean or median age, coronary artery disease, hypertension, diabetes, concomitant QT-prolonging medications, intensive care unit admission, and severity of illness in the study populations explained between-studies heterogeneity.</AbstractText>
<AbstractText Label="Conclusion" NlmCategory="UNASSIGNED">Treatment of patients with COVID-19 with CQ or HCQ is associated with an important risk of drug-induced QT prolongation and relatively higher incidence of torsades de pointes, ventricular tachycardia, or cardiac arrest. Therefore, these agents should not be used routinely in the management of COVID-19 disease. Patients with COVID-19 who are treated with antimalarials for other indications should be adequately monitored.</AbstractText>
<CopyrightInformation>© 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Tleyjeh</LastName>
<ForeName>Imad M</ForeName>
<Initials>IM</Initials>
<AffiliationInfo><Affiliation>Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Kashour</LastName>
<ForeName>Zakariya</ForeName>
<Initials>Z</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>AlDosary</LastName>
<ForeName>Oweida</ForeName>
<Initials>O</Initials>
<AffiliationInfo><Affiliation>Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Riaz</LastName>
<ForeName>Muhammad</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department of Statistics, Quaid Azam University Islamabad, Pakistan.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Tlayjeh</LastName>
<ForeName>Haytham</ForeName>
<Initials>H</Initials>
<AffiliationInfo><Affiliation>Department of Intensive Care, King Abdulaziz Medical City, King Saud bin Abdulaziz for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Garbati</LastName>
<ForeName>Musa A</ForeName>
<Initials>MA</Initials>
<AffiliationInfo><Affiliation>Infectious Diseases Unit, Department of Medicine, University of Maiduguri, Maiduguri, Nigeria.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Tleyjeh</LastName>
<ForeName>Rana</ForeName>
<Initials>R</Initials>
<AffiliationInfo><Affiliation>College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Al-Mallah</LastName>
<ForeName>Mouaz H</ForeName>
<Initials>MH</Initials>
<AffiliationInfo><Affiliation>Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Sohail</LastName>
<ForeName>M Rizwan</ForeName>
<Initials>MR</Initials>
<AffiliationInfo><Affiliation>Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Gerberi</LastName>
<ForeName>Dana</ForeName>
<Initials>D</Initials>
<AffiliationInfo><Affiliation>Mayo Clinic Libraries, Mayo Clinic, Rochester, MN.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Bin Abdulhak</LastName>
<ForeName>Aref A</ForeName>
<Initials>AA</Initials>
<AffiliationInfo><Affiliation>Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Giudicessi</LastName>
<ForeName>John R</ForeName>
<Initials>JR</Initials>
<AffiliationInfo><Affiliation>Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ackerman</LastName>
<ForeName>Michael J</ForeName>
<Initials>MJ</Initials>
<AffiliationInfo><Affiliation>Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Kashour</LastName>
<ForeName>Tarek</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2020</Year>
<Month>11</Month>
<Day>02</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo><Country>Netherlands</Country>
<MedlineTA>Mayo Clin Proc Innov Qual Outcomes</MedlineTA>
<NlmUniqueID>101728275</NlmUniqueID>
<ISSNLinking>2542-4548</ISSNLinking>
</MedlineJournalInfo>
<KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">CAD, coronary artery disease</Keyword>
<Keyword MajorTopicYN="N">COVID-19, coronavirus disease 2019</Keyword>
<Keyword MajorTopicYN="N">CQ, chloroquine</Keyword>
<Keyword MajorTopicYN="N">DM, diabetes mellitus</Keyword>
<Keyword MajorTopicYN="N">HCQ, hydroxychloroquine</Keyword>
<Keyword MajorTopicYN="N">ICU, intensive care unit</Keyword>
<Keyword MajorTopicYN="N">SARS-CoV-2, severe acute respiratory syndrome coronavirus 2</Keyword>
<Keyword MajorTopicYN="N">TdP, torsades de pointes</Keyword>
</KeywordList>
</MedlineCitation>
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<Month>11</Month>
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<Hour>6</Hour>
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