TY - JOUR
T1 - Safety and Effectiveness of Hydroxychloroquine and Azithromycin Combination Therapy for Treatment of Hospitalized Patients with COVID-19
T2 - A Propensity-Matched Study
AU - Huang, Henry D.
AU - Jneid, Hani
AU - Aziz, Mariam
AU - Ravi, Venkatesh
AU - Sharma, Parikshit S.
AU - Larsen, Timothy
AU - Chatterjee, Neal
AU - Saour, Basil
AU - Aziz, Zaid
AU - Nayak, Hemal
AU - Trohman, Richard G.
AU - Krishnan, Kousik
N1 - Funding Information:
No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Henry Huang, Hani Jneid, Mariam Aziz, Venkatesh Ravi, Parikshit S. Sharma, Timothy Larsen, Neal Chatterjee, Basil Saour, Zaid Aziz, Hemal Nayak, Richard Trohman, and Kousik Krishnan have nothing to disclose. The study was undertaken with the approval of the institutional review board of Rush University Medical Center. The study was performed in accordance with the declaration of Helsinki 1964 and its later amendments. Informed consent was not obtained from patients owing to the nature of the study being a retrospective chart review. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Introduction: We sought to determine the effectiveness and safety of hydroxychloroquine–azithromycin (HCQ-AZM) therapy in hospitalized patients with COVID-19. Methods: This was a retrospective cohort study of 613 patients hospitalized (integrated health system involving three hospitals) for RT-PCR-confirmed COVID-19 infection between March 1, 2020 and April 25, 2020. Intervention was treatment with HCQ-AZM in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Outcomes of interest were in-hospital all-cause mortality, cardiovascular mortality, pulseless electrical activity (PEA) arrest, non-lethal arrhythmias, and length of hospital stay. Secondary measures included in-hospital corrected QT (QTc) interval parameters and serum biomarkers levels. Results: Propensity-matched groups were composed of 173 patients given HCQ-AZM and 173 matched patients who did not receive treatment. There was no significant difference in in-hospital mortality (odds ratio [OR] 1.52; 95% confidence interval [CI] 0.80–2.89; p = 0.2), PEA arrest (OR 1.68, CI 0.68–4.15; p = 0.27), or incidence of non-lethal arrhythmias (10.4% vs. 6.8%; p = 0.28). Length of hospital stay (10.5 ± 7.4 vs. 5.8 ± 6.1; p < 0.001), peak CRP levels (252 ± 136 vs. 166 ± 124; p < 0.0001), and degree of QTc interval prolongation was higher for the HCQ-AZM group (28 ± 32 vs. 9 ± 32; p < 0.0001), but there was no significant difference in incidence of sustained ventricular arrhythmias (2.8% vs. 1.7%; p = 0.52). HCQ-AZM was stopped in 10 patients because of QT interval prolongation and 1 patient because of drug-related polymorphic ventricular tachycardia. Conclusion: In this propensity-matched study, there was no difference in in-hospital mortality, life-threatening arrhythmias, or incidence of PEA arrest between the HCQ-AZM and untreated control groups. QTc intervals were longer in patients receiving HCQ-AZM, but only one patient developed drug-related ventricular tachycardia.
AB - Introduction: We sought to determine the effectiveness and safety of hydroxychloroquine–azithromycin (HCQ-AZM) therapy in hospitalized patients with COVID-19. Methods: This was a retrospective cohort study of 613 patients hospitalized (integrated health system involving three hospitals) for RT-PCR-confirmed COVID-19 infection between March 1, 2020 and April 25, 2020. Intervention was treatment with HCQ-AZM in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Outcomes of interest were in-hospital all-cause mortality, cardiovascular mortality, pulseless electrical activity (PEA) arrest, non-lethal arrhythmias, and length of hospital stay. Secondary measures included in-hospital corrected QT (QTc) interval parameters and serum biomarkers levels. Results: Propensity-matched groups were composed of 173 patients given HCQ-AZM and 173 matched patients who did not receive treatment. There was no significant difference in in-hospital mortality (odds ratio [OR] 1.52; 95% confidence interval [CI] 0.80–2.89; p = 0.2), PEA arrest (OR 1.68, CI 0.68–4.15; p = 0.27), or incidence of non-lethal arrhythmias (10.4% vs. 6.8%; p = 0.28). Length of hospital stay (10.5 ± 7.4 vs. 5.8 ± 6.1; p < 0.001), peak CRP levels (252 ± 136 vs. 166 ± 124; p < 0.0001), and degree of QTc interval prolongation was higher for the HCQ-AZM group (28 ± 32 vs. 9 ± 32; p < 0.0001), but there was no significant difference in incidence of sustained ventricular arrhythmias (2.8% vs. 1.7%; p = 0.52). HCQ-AZM was stopped in 10 patients because of QT interval prolongation and 1 patient because of drug-related polymorphic ventricular tachycardia. Conclusion: In this propensity-matched study, there was no difference in in-hospital mortality, life-threatening arrhythmias, or incidence of PEA arrest between the HCQ-AZM and untreated control groups. QTc intervals were longer in patients receiving HCQ-AZM, but only one patient developed drug-related ventricular tachycardia.
KW - COVID-19
KW - Hydroxychloroquine
KW - SARS-CoV-2
KW - Torsades de pointes
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U2 - 10.1007/s40119-020-00201-7
DO - 10.1007/s40119-020-00201-7
M3 - Article
AN - SCOPUS:85099614115
SN - 2193-8261
VL - 9
SP - 523
EP - 534
JO - Cardiology and Therapy
JF - Cardiology and Therapy
IS - 2
ER -