Hydroxychloroquine and azithromycin tolerance in haemodialysis patients during COVID-19 infection.
Identifieur interne : 000D91 ( Main/Corpus ); précédent : 000D90; suivant : 000D92Hydroxychloroquine and azithromycin tolerance in haemodialysis patients during COVID-19 infection.
Auteurs : Philippe Giaime ; Maxime Guenoun ; Nathalie Pedinielli ; Hervé Narbonne ; Jean-Philippe Bergounioux ; Caroline Solas ; Romain Guilhaumou ; Jérôme Sampol ; Jacques Ollier ; Hélène Sichez ; Marianne Serveaux ; Flora Brunner ; Stanislas BatailleSource :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [ 1460-2385 ] ; 2020.
English descriptors
- KwdEn :
- Aged (MeSH), Anti-Bacterial Agents (therapeutic use), Antimalarials (therapeutic use), Azithromycin (therapeutic use), Betacoronavirus (MeSH), COVID-19 (MeSH), Comorbidity (MeSH), Coronavirus Infections (drug therapy), Coronavirus Infections (epidemiology), Drug Tolerance (MeSH), Female (MeSH), France (epidemiology), Humans (MeSH), Hydroxychloroquine (therapeutic use), Kidney Failure, Chronic (epidemiology), Kidney Failure, Chronic (therapy), Male (MeSH), Pandemics (MeSH), Pneumonia, Viral (drug therapy), Pneumonia, Viral (epidemiology), Renal Dialysis (methods), SARS-CoV-2 (MeSH).
- MESH :
- chemical , therapeutic use : Anti-Bacterial Agents, Antimalarials, Azithromycin, Hydroxychloroquine.
- geographic , epidemiology : France.
- drug therapy : Coronavirus Infections, Pneumonia, Viral.
- epidemiology : Coronavirus Infections, Kidney Failure, Chronic, Pneumonia, Viral.
- methods : Renal Dialysis.
- therapy : Kidney Failure, Chronic.
- Aged, Betacoronavirus, COVID-19, Comorbidity, Drug Tolerance, Female, Humans, Male, Pandemics, SARS-CoV-2.
Abstract
BACKGROUND
Haemodialysis patients are at risk of developing severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: coronavirus disease 2019 (COVID-19). In March 2020, hydroxychloroquine (HCQ) and azithromycin (AZI) were proposed as potential treatments of COVID-19, but with warnings concerning their possible toxicity. No data are available regarding the toxicity of this treatment in haemodialysis patients.
METHODS
We report the use of HCQ and AZI in a cohort of COVID-19 haemodialysis patients with focus on safety concerns.
RESULTS
Twenty-one patients received 200 mg HCQ thrice daily during 10 days, and AZI 500 mg on Day 1, and 250 mg on the four following days. HCQ plasma concentrations were within the recommended range (0.1-1.0 µg/mL) in all patients except one, in which maximum concentration was 1.1 µg/mL. HCQ concentration raised until the third day and remained stable thereafter. No cardiac event occurred in spite of progressive lengthening of corrected QT interval (QTc) during the treatment. One patient experienced a long QTc syndrome (QTc >500 ms) without any arrhythmia episode, although HCQ concentration was in the target range. Five (23.8%) patients experienced hypoglycaemia, a well-known HCQ side-effect. SARS-CoV-2 RNA remained detectable in nasopharyngeal swabs for a long time in haemodialysis patients (mean time 21 days).
CONCLUSIONS
HCQ and AZI are safe in haemodialysis patients at these doses but can lead to long QTc syndrome and hypoglycaemia. HCQ concentrations were not correlated with side effects. We recommend monitoring of the QTc length throughout treatment, as well as glycaemia. SARS-CoV-2 could persist for longer in haemodialysis patients than in the general population.
DOI: 10.1093/ndt/gfaa191
PubMed: 32844224
PubMed Central: PMC7499716
Links to Exploration step
pubmed:32844224Le document en format XML
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<author><name sortKey="Serveaux, Marianne" sort="Serveaux, Marianne" uniqKey="Serveaux M" first="Marianne" last="Serveaux">Marianne Serveaux</name>
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<affiliation><nlm:affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Brunner, Flora" sort="Brunner, Flora" uniqKey="Brunner F" first="Flora" last="Brunner">Flora Brunner</name>
<affiliation><nlm:affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</nlm:affiliation>
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<author><name sortKey="Bataille, Stanislas" sort="Bataille, Stanislas" uniqKey="Bataille S" first="Stanislas" last="Bataille">Stanislas Bataille</name>
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<author><name sortKey="Pedinielli, Nathalie" sort="Pedinielli, Nathalie" uniqKey="Pedinielli N" first="Nathalie" last="Pedinielli">Nathalie Pedinielli</name>
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<author><name sortKey="Bergounioux, Jean Philippe" sort="Bergounioux, Jean Philippe" uniqKey="Bergounioux J" first="Jean-Philippe" last="Bergounioux">Jean-Philippe Bergounioux</name>
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<author><name sortKey="Solas, Caroline" sort="Solas, Caroline" uniqKey="Solas C" first="Caroline" last="Solas">Caroline Solas</name>
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</affiliation>
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<author><name sortKey="Guilhaumou, Romain" sort="Guilhaumou, Romain" uniqKey="Guilhaumou R" first="Romain" last="Guilhaumou">Romain Guilhaumou</name>
<affiliation><nlm:affiliation>Service de Pharmacologie Clinique et Pharmacovigilance, APHM, Institut de Neurosciences des Systèmes, Inserm UMR 1106, Université d'Aix-Marseille, Marseille, France.</nlm:affiliation>
</affiliation>
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<affiliation><nlm:affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Ollier, Jacques" sort="Ollier, Jacques" uniqKey="Ollier J" first="Jacques" last="Ollier">Jacques Ollier</name>
<affiliation><nlm:affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Sichez, Helene" sort="Sichez, Helene" uniqKey="Sichez H" first="Hélène" last="Sichez">Hélène Sichez</name>
<affiliation><nlm:affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Serveaux, Marianne" sort="Serveaux, Marianne" uniqKey="Serveaux M" first="Marianne" last="Serveaux">Marianne Serveaux</name>
<affiliation><nlm:affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Brunner, Flora" sort="Brunner, Flora" uniqKey="Brunner F" first="Flora" last="Brunner">Flora Brunner</name>
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</affiliation>
<affiliation><nlm:affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Bataille, Stanislas" sort="Bataille, Stanislas" uniqKey="Bataille S" first="Stanislas" last="Bataille">Stanislas Bataille</name>
<affiliation><nlm:affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Aix Marseille Université, INSERM, INRAE, C2VN, Marseille, France.</nlm:affiliation>
</affiliation>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term>
<term>Anti-Bacterial Agents (therapeutic use)</term>
<term>Antimalarials (therapeutic use)</term>
<term>Azithromycin (therapeutic use)</term>
<term>Betacoronavirus (MeSH)</term>
<term>COVID-19 (MeSH)</term>
<term>Comorbidity (MeSH)</term>
<term>Coronavirus Infections (drug therapy)</term>
<term>Coronavirus Infections (epidemiology)</term>
<term>Drug Tolerance (MeSH)</term>
<term>Female (MeSH)</term>
<term>France (epidemiology)</term>
<term>Humans (MeSH)</term>
<term>Hydroxychloroquine (therapeutic use)</term>
<term>Kidney Failure, Chronic (epidemiology)</term>
<term>Kidney Failure, Chronic (therapy)</term>
<term>Male (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumonia, Viral (drug therapy)</term>
<term>Pneumonia, Viral (epidemiology)</term>
<term>Renal Dialysis (methods)</term>
<term>SARS-CoV-2 (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Bacterial Agents</term>
<term>Antimalarials</term>
<term>Azithromycin</term>
<term>Hydroxychloroquine</term>
</keywords>
<keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>France</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Kidney Failure, Chronic</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Renal Dialysis</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Kidney Failure, Chronic</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Betacoronavirus</term>
<term>COVID-19</term>
<term>Comorbidity</term>
<term>Drug Tolerance</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Pandemics</term>
<term>SARS-CoV-2</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>Haemodialysis patients are at risk of developing severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: coronavirus disease 2019 (COVID-19). In March 2020, hydroxychloroquine (HCQ) and azithromycin (AZI) were proposed as potential treatments of COVID-19, but with warnings concerning their possible toxicity. No data are available regarding the toxicity of this treatment in haemodialysis patients.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>We report the use of HCQ and AZI in a cohort of COVID-19 haemodialysis patients with focus on safety concerns.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>Twenty-one patients received 200 mg HCQ thrice daily during 10 days, and AZI 500 mg on Day 1, and 250 mg on the four following days. HCQ plasma concentrations were within the recommended range (0.1-1.0 µg/mL) in all patients except one, in which maximum concentration was 1.1 µg/mL. HCQ concentration raised until the third day and remained stable thereafter. No cardiac event occurred in spite of progressive lengthening of corrected QT interval (QTc) during the treatment. One patient experienced a long QTc syndrome (QTc >500 ms) without any arrhythmia episode, although HCQ concentration was in the target range. Five (23.8%) patients experienced hypoglycaemia, a well-known HCQ side-effect. SARS-CoV-2 RNA remained detectable in nasopharyngeal swabs for a long time in haemodialysis patients (mean time 21 days).</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>HCQ and AZI are safe in haemodialysis patients at these doses but can lead to long QTc syndrome and hypoglycaemia. HCQ concentrations were not correlated with side effects. We recommend monitoring of the QTc length throughout treatment, as well as glycaemia. SARS-CoV-2 could persist for longer in haemodialysis patients than in the general population.</p>
</div>
</front>
</TEI>
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<DateCompleted><Year>2020</Year>
<Month>09</Month>
<Day>15</Day>
</DateCompleted>
<DateRevised><Year>2020</Year>
<Month>12</Month>
<Day>18</Day>
</DateRevised>
<Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1460-2385</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>35</Volume>
<Issue>8</Issue>
<PubDate><Year>2020</Year>
<Month>08</Month>
<Day>01</Day>
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<Title>Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association</Title>
<ISOAbbreviation>Nephrol Dial Transplant</ISOAbbreviation>
</Journal>
<ArticleTitle>Hydroxychloroquine and azithromycin tolerance in haemodialysis patients during COVID-19 infection.</ArticleTitle>
<Pagination><MedlinePgn>1346-1353</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1093/ndt/gfaa191</ELocationID>
<Abstract><AbstractText Label="BACKGROUND">Haemodialysis patients are at risk of developing severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: coronavirus disease 2019 (COVID-19). In March 2020, hydroxychloroquine (HCQ) and azithromycin (AZI) were proposed as potential treatments of COVID-19, but with warnings concerning their possible toxicity. No data are available regarding the toxicity of this treatment in haemodialysis patients.</AbstractText>
<AbstractText Label="METHODS">We report the use of HCQ and AZI in a cohort of COVID-19 haemodialysis patients with focus on safety concerns.</AbstractText>
<AbstractText Label="RESULTS">Twenty-one patients received 200 mg HCQ thrice daily during 10 days, and AZI 500 mg on Day 1, and 250 mg on the four following days. HCQ plasma concentrations were within the recommended range (0.1-1.0 µg/mL) in all patients except one, in which maximum concentration was 1.1 µg/mL. HCQ concentration raised until the third day and remained stable thereafter. No cardiac event occurred in spite of progressive lengthening of corrected QT interval (QTc) during the treatment. One patient experienced a long QTc syndrome (QTc >500 ms) without any arrhythmia episode, although HCQ concentration was in the target range. Five (23.8%) patients experienced hypoglycaemia, a well-known HCQ side-effect. SARS-CoV-2 RNA remained detectable in nasopharyngeal swabs for a long time in haemodialysis patients (mean time 21 days).</AbstractText>
<AbstractText Label="CONCLUSIONS">HCQ and AZI are safe in haemodialysis patients at these doses but can lead to long QTc syndrome and hypoglycaemia. HCQ concentrations were not correlated with side effects. We recommend monitoring of the QTc length throughout treatment, as well as glycaemia. SARS-CoV-2 could persist for longer in haemodialysis patients than in the general population.</AbstractText>
<CopyrightInformation>© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Giaime</LastName>
<ForeName>Philippe</ForeName>
<Initials>P</Initials>
<AffiliationInfo><Affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Guenoun</LastName>
<ForeName>Maxime</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department of Cardiology, Clinique Bouchard, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Pedinielli</LastName>
<ForeName>Nathalie</ForeName>
<Initials>N</Initials>
<AffiliationInfo><Affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Narbonne</LastName>
<ForeName>Hervé</ForeName>
<Initials>H</Initials>
<AffiliationInfo><Affiliation>Department of Endocrinology, Clinique Bouchard, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Bergounioux</LastName>
<ForeName>Jean-Philippe</ForeName>
<Initials>JP</Initials>
<AffiliationInfo><Affiliation>Laboratoire Cerballiance Provence, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Solas</LastName>
<ForeName>Caroline</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Aix-Marseille Université, APHM, Unité des Virus Emergents (UVE) IRD 190, INSERM 1207, Laboratoire de Pharmacocinétique et Toxicologie, Hôpital La Timone, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Guilhaumou</LastName>
<ForeName>Romain</ForeName>
<Initials>R</Initials>
<AffiliationInfo><Affiliation>Service de Pharmacologie Clinique et Pharmacovigilance, APHM, Institut de Neurosciences des Systèmes, Inserm UMR 1106, Université d'Aix-Marseille, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Sampol</LastName>
<ForeName>Jérôme</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ollier</LastName>
<ForeName>Jacques</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Association pour le Traitement des Urémiques en Provence, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Sichez</LastName>
<ForeName>Hélène</ForeName>
<Initials>H</Initials>
<AffiliationInfo><Affiliation>Phocean Nephrology Institute, Clinique Bouchard, Marseille, France.</Affiliation>
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