Effect of COVID‐19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey

Abstract

All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Remdesivir-Associated Significant Bradycardia: A Report of Three Cases

“…The association between remdesivir and the QTc interval prolongation has been observed in a few reports. 14 , 16 - 17 In a recent study, 9% of patients (6/67) who received remdesivir had QTc interval prolongation. Their analysis showed that receiving remdesivir alone was not a predictor of the QTc interval prolongation.…”

Arrhythmogenic Risk and Mechanisms of QT-Prolonging Drugs to Treat COVID-19

“…Oseltamivir is an antiviral drug that inhibits Neuraminidase, expressed on the viral surface, which plays an essential role in viral entry to host cells, viral release from infected cells, and subsequent viral spread. Although its role in COVID-19 is very limited, it is noteworthy to mention that Haghjoo et al 51 reported that this drug may significantly prolong QTc when used in combination with HCQ, as also suggested by Çelik et al 56 . No TdP were noted in these patients, as in previous pre-clinical models which tested oseltamivir therapy alone, since this drug is capable to inhibits both inward and outward currents 57 .…”

“…It should be noted that in this case, patients were also on AM while receiving remdesivir, which is well-known to prolong the QT interval. Remdesivir monotherapy has indeed shown to prolong QTc in the Haghjoo et al 51 analysis, although keeping a low-risk profile in terms of QT prolongation and TdP induction. Moreover, no major cardiac arrhythmia events were described in the largest trial assessing remdesivir efficacy and safety profile.…”

“…No significant QTc prolongation was noted with monotherapy, when compared to HCQ or HCQ + favipiravir. On the other side, Haghjoo et al 51 observed a mild QTc prolongation in most cases, without TdP events, even if they concluded that favipiravir monotherapy was safer than other COVID-19 mediations in terms of QTc prolongation.…”

“…Indeed, this combination has an intrinsic risk of ventricular tachycardia (VT, 0.03%), VF (0.03%) and TdP (0.09%) reported in the literature, according to the EUDRA vigilance from EMA. During the pandemic, Haghjoo et al 51 investigated the potential QT-prolonging role of LPV/RTN, showing a significant increase in QTc during drug therapy (along with CQ, HCQ, atazanavir/ritonavir, oseltamivir, favipiravir J o u r n a l P r e -p r o o f and remdesivir alone in combination with AM). Nevertheless, in this cohort, TdP occurred overall rarely (n=9; 0.385), with 4 patients treated with HCQ + AM, while 5 patients were treated with LPN/RTV + AM.…”