Hydroxychloroquine and QTc prolongation in patients with COVID-19: A systematic review and meta-analysis.
Identifieur interne : 000A00 ( Main/Corpus ); précédent : 000999; suivant : 000A01Hydroxychloroquine and QTc prolongation in patients with COVID-19: A systematic review and meta-analysis.
Auteurs : Sourabh Agstam ; Ashutosh Yadav ; Praveen Kumar-M ; Ankur GuptaSource :
- Indian pacing and electrophysiology journal [ 0972-6292 ]
Abstract
Background
Among many drugs that hold potential in COVID-19 pandemic, chloroquine (CQ), and its derivative hydroxychloroquine (HCQ) have generated unusual interest. With increasing usage, there has been growing concern about the prolongation of QTc interval and Torsades de Pointes (TdP) with HCQ, especially in combination with azithromycin.
Aims
This meta-analysis is planned to study the risk of QTc prolongation and Torsades de pointes (TdP) by a well-defined criterion for HCQ, CQ alone, and in combination with Azithromycin in patients with COVID-19.
Methods
A comprehensive literature search was made in two databases (PubMed, Embase). Three outcomes explored in the included studies were frequency of QTc > 500 ms (ms) or ΔQTc > 60 ms (Outcome 1), frequency of QTc > 500 ms (Outcome 2) and frequency of TdP (Outcome 3). Random effects method with inverse variance approach was used for computation of pooled summary and risk ratio.
Results
A total of 13 studies comprising of 2138 patients were included in the final analysis. The pooled prevalence of outcome 1, outcome 2 and outcome 3 for HCQ, CQ with or without Azithromycin were 10.18% (5.59-17.82%, I
Conclusion
The use of HCQ/CQ is associated with a high prevalence of QTc prolongation. However, it is not associated with a high risk of TdP.
DOI: 10.1016/j.ipej.2020.10.002
PubMed: 33075484
PubMed Central: PMC7563579
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pubmed:33075484Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Hydroxychloroquine and QTc prolongation in patients with COVID-19: A systematic review and meta-analysis.</title><author><name sortKey="Agstam, Sourabh" sort="Agstam, Sourabh" uniqKey="Agstam S" first="Sourabh" last="Agstam">Sourabh Agstam</name><affiliation><nlm:affiliation>Department of Cardiology, VMMC & Safdarjung Hospital, New Delhi, India.</nlm:affiliation></affiliation></author><author><name sortKey="Yadav, Ashutosh" sort="Yadav, Ashutosh" uniqKey="Yadav A" first="Ashutosh" last="Yadav">Ashutosh Yadav</name><affiliation><nlm:affiliation>Department of Cardiology, Fortis Hospital, Mohali, Punjab, India.</nlm:affiliation></affiliation></author><author><name sortKey="Kumar M, Praveen" sort="Kumar M, Praveen" uniqKey="Kumar M P" first="Praveen" last="Kumar-M">Praveen Kumar-M</name><affiliation><nlm:affiliation>Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.</nlm:affiliation></affiliation></author><author><name sortKey="Gupta, Ankur" sort="Gupta, Ankur" uniqKey="Gupta A" first="Ankur" last="Gupta">Ankur Gupta</name><affiliation><nlm:affiliation>Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: ag_pgi@yahoo.com.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2021">2021 Jan-Feb</date><idno type="RBID">pubmed:33075484</idno><idno type="pmid">33075484</idno><idno type="doi">10.1016/j.ipej.2020.10.002</idno><idno type="pmc">PMC7563579</idno><idno type="wicri:Area/Main/Corpus">000A00</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000A00</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Hydroxychloroquine and QTc prolongation in patients with COVID-19: A systematic review and meta-analysis.</title><author><name sortKey="Agstam, Sourabh" sort="Agstam, Sourabh" uniqKey="Agstam S" first="Sourabh" last="Agstam">Sourabh Agstam</name><affiliation><nlm:affiliation>Department of Cardiology, VMMC & Safdarjung Hospital, New Delhi, India.</nlm:affiliation></affiliation></author><author><name sortKey="Yadav, Ashutosh" sort="Yadav, Ashutosh" uniqKey="Yadav A" first="Ashutosh" last="Yadav">Ashutosh Yadav</name><affiliation><nlm:affiliation>Department of Cardiology, Fortis Hospital, Mohali, Punjab, India.</nlm:affiliation></affiliation></author><author><name sortKey="Kumar M, Praveen" sort="Kumar M, Praveen" uniqKey="Kumar M P" first="Praveen" last="Kumar-M">Praveen Kumar-M</name><affiliation><nlm:affiliation>Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.</nlm:affiliation></affiliation></author><author><name sortKey="Gupta, Ankur" sort="Gupta, Ankur" uniqKey="Gupta A" first="Ankur" last="Gupta">Ankur Gupta</name><affiliation><nlm:affiliation>Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: ag_pgi@yahoo.com.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Indian pacing and electrophysiology journal</title><idno type="ISSN">0972-6292</idno></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Background</b></p><p>Among many drugs that hold potential in COVID-19 pandemic, chloroquine (CQ), and its derivative hydroxychloroquine (HCQ) have generated unusual interest. With increasing usage, there has been growing concern about the prolongation of QTc interval and Torsades de Pointes (TdP) with HCQ, especially in combination with azithromycin.</p></div><div type="abstract" xml:lang="en"><p><b>Aims</b></p><p>This meta-analysis is planned to study the risk of QTc prolongation and Torsades de pointes (TdP) by a well-defined criterion for HCQ, CQ alone, and in combination with Azithromycin in patients with COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>Methods</b></p><p>A comprehensive literature search was made in two databases (PubMed, Embase). Three outcomes explored in the included studies were frequency of QTc > 500 ms (ms) or ΔQTc > 60 ms (Outcome 1), frequency of QTc > 500 ms (Outcome 2) and frequency of TdP (Outcome 3). Random effects method with inverse variance approach was used for computation of pooled summary and risk ratio.</p></div><div type="abstract" xml:lang="en"><p><b>Results</b></p><p>A total of 13 studies comprising of 2138 patients were included in the final analysis. The pooled prevalence of outcome 1, outcome 2 and outcome 3 for HCQ, CQ with or without Azithromycin were 10.18% (5.59-17.82%, I</p></div><div type="abstract" xml:lang="en"><p><b>Conclusion</b></p><p>The use of HCQ/CQ is associated with a high prevalence of QTc prolongation. However, it is not associated with a high risk of TdP.</p></div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">33075484</PMID><DateRevised><Year>2021</Year><Month>02</Month><Day>01</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Print">0972-6292</ISSN><JournalIssue CitedMedium="Print"><Volume>21</Volume><Issue>1</Issue><PubDate><MedlineDate>2021 Jan-Feb</MedlineDate></PubDate></JournalIssue><Title>Indian pacing and electrophysiology journal</Title><ISOAbbreviation>Indian Pacing Electrophysiol J</ISOAbbreviation></Journal><ArticleTitle>Hydroxychloroquine and QTc prolongation in patients with COVID-19: A systematic review and meta-analysis.</ArticleTitle><Pagination><MedlinePgn>36-43</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0972-6292(20)30116-9</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.ipej.2020.10.002</ELocationID><Abstract><AbstractText Label="Background" NlmCategory="UNASSIGNED">Among many drugs that hold potential in COVID-19 pandemic, chloroquine (CQ), and its derivative hydroxychloroquine (HCQ) have generated unusual interest. With increasing usage, there has been growing concern about the prolongation of QTc interval and Torsades de Pointes (TdP) with HCQ, especially in combination with azithromycin.</AbstractText><AbstractText Label="Aims" NlmCategory="UNASSIGNED">This meta-analysis is planned to study the risk of QTc prolongation and Torsades de pointes (TdP) by a well-defined criterion for HCQ, CQ alone, and in combination with Azithromycin in patients with COVID-19.</AbstractText><AbstractText Label="Methods" NlmCategory="UNASSIGNED">A comprehensive literature search was made in two databases (PubMed, Embase). Three outcomes explored in the included studies were frequency of QTc > 500 ms (ms) or ΔQTc > 60 ms (Outcome 1), frequency of QTc > 500 ms (Outcome 2) and frequency of TdP (Outcome 3). Random effects method with inverse variance approach was used for computation of pooled summary and risk ratio.</AbstractText><AbstractText Label="Results" NlmCategory="UNASSIGNED">A total of 13 studies comprising of 2138 patients were included in the final analysis. The pooled prevalence of outcome 1, outcome 2 and outcome 3 for HCQ, CQ with or without Azithromycin were 10.18% (5.59-17.82%, I<sup>2</sup> - 92%), 10.22% (6.01-16.85%, I<sup>2</sup> - 79%), and 0.72% (0.34-1.51, I<sup>2</sup> - 0%) respectively. The prevalence of outcome 2 in subgroup analysis for HCQ and HCQ + Azithromycin was 7.25% (3.22-15.52, I<sup>2</sup> - 59%) and 8.61% (4.52-15.79, I<sup>2</sup> - 76%), respectively. The risk ratio (RR) for outcome 1 and outcome 2 between HCQ + Azithromycin and HCQ was 1.22 (0.77-1.93, I<sup>2</sup> - 0%) & 1.51 (0.79-2.87, I<sup>2</sup> - 13%), respectively and was not significant. Heterogeneity was noted statistically as well clinically (regimen types, patient numbers, study design, and outcome definition).</AbstractText><AbstractText Label="Conclusion" NlmCategory="UNASSIGNED">The use of HCQ/CQ is associated with a high prevalence of QTc prolongation. However, it is not associated with a high risk of TdP.</AbstractText><CopyrightInformation>© 2020 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Agstam</LastName><ForeName>Sourabh</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Cardiology, VMMC & Safdarjung Hospital, New Delhi, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yadav</LastName><ForeName>Ashutosh</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Fortis Hospital, Mohali, Punjab, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kumar-M</LastName><ForeName>Praveen</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gupta</LastName><ForeName>Ankur</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: ag_pgi@yahoo.com.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>10</Month><Day>16</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>Indian Pacing Electrophysiol J</MedlineTA><NlmUniqueID>101157207</NlmUniqueID><ISSNLinking>0972-6292</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Aminoquinoline</Keyword><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">COVID-19, Coronavirus disease2019</Keyword><Keyword MajorTopicYN="N">CQ, Chloroquine</Keyword><Keyword MajorTopicYN="N">Chloroquine</Keyword><Keyword MajorTopicYN="N">Coronavirus</Keyword><Keyword MajorTopicYN="N">EAD, Early afterdepolarization</Keyword><Keyword MajorTopicYN="N">ECG, Electrocardiography</Keyword><Keyword MajorTopicYN="N">HCQ, Hydroxychloroquine</Keyword><Keyword MajorTopicYN="N">HERG, human ether-a-go-go-related gene</Keyword><Keyword MajorTopicYN="N">Hydroxychloroquine</Keyword><Keyword MajorTopicYN="N">ICU, Intensive care unit</Keyword><Keyword MajorTopicYN="N">QTc prolongation</Keyword><Keyword MajorTopicYN="N">RCT, Randomized control trial</Keyword><Keyword MajorTopicYN="N">RR, Risk ratio</Keyword><Keyword MajorTopicYN="N">SA, Sinoatrial</Keyword><Keyword MajorTopicYN="N">SARS-CoV-2</Keyword><Keyword MajorTopicYN="N">SARS-CoV-2, severe acute respiratory syndrome coronavirus 2</Keyword><Keyword MajorTopicYN="N">TdP, Torsades de pointes</Keyword><Keyword MajorTopicYN="N">Torsades de pointes</Keyword><Keyword MajorTopicYN="N">VT, Ventricular tachycardia</Keyword><Keyword MajorTopicYN="N">WHO, World Health organization</Keyword></KeywordList><CoiStatement>None.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>08</Month><Day>05</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>09</Month><Day>11</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>10</Month><Day>15</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>10</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>10</Month><Day>20</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>10</Month><Day>19</Day><Hour>20</Hour><Minute>9</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33075484</ArticleId><ArticleId IdType="pii">S0972-6292(20)30116-9</ArticleId><ArticleId IdType="doi">10.1016/j.ipej.2020.10.002</ArticleId><ArticleId IdType="pmc">PMC7563579</ArticleId></ArticleIdList><pmc-dir>pmcsd</pmc-dir>
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