Suspected Hydroxychloroquine-Associated QT-Interval Prolongation in a Patient With Systemic Lupus Erythematosus

Morgan, Nadia D.; Patel, Sheetal; Dvorkina, Olga

doi:10.1097/rhu.0b013e31829d5e50

Cited by 81 publications

(70 citation statements)

References 14 publications

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“…Moreover, QT interval prolongation has been noted in numerous studies. [19][20][21][22] Severely prolonged QT interval can lead to lethal arrhythmias and sudden cardiac death. Therefore, the prevalence of these cardiovascular AEs warrants periodic electrocardiogram (ECG) monitoring when participants are undergoing these therapies, as cardiovascular AEs can be fatal.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Hydroxychloroquine and Chloroquine Safety Profiles – A Systematic Review and Meta-Analysis

Ren

Overton

et al. 2020

Preprint

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Background:Recently, chloroquine (CQ) and its derivative hydroxychloroquine (HCQ) have emerged as potential antiviral and immunomodulatory options for the treatment of 2019 coronavirus disease . To examine the safety profiles of these medications, we systematically evaluated the adverse events (AEs) of these medications from published randomized controlled trials (RCTs). Methods: We systematically searched PubMed, MEDLINE, Cochrane, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the ClinicalTrials.gov for all the RCTs comparing CQ or HCQ with placebo or other active agents, published before March 31, 2020. The random-effects or fixed-effects models were used to pool the risk estimates relative ratio (RR) with 95% confidence interval (CI) for the outcomes. Results: The literature search yielded 23 and 17 studies for CQ and HCQ, respectively, that satisfied our inclusion criteria. Of these studies, we performed meta-analysis on the ones that were placebo-controlled, which included 6 studies for CQ and 14 studies for HCQ. We did not limit our analysis to published reports involving viral treatment alone; data also included the usage of either CQ or HCQ for the treatment of other diseases. The trials for the CQ consisted of a total of 2,137 participants (n=1,077 CQ, n=1,060 placebo), while the trials for HCQ involved 1,096 participants (n=558 HCQ and n=538 placebo). The overall mild or total AEs were statistically higher comparing CQ or HCQ to placebo. The AEs were further categorized into four groups and analyses revealed that neurologic, gastrointestinal, dermatologic, and ophthalmic AEs were higher in participants taking CQ compared to placebo. Although this was not evident in HCQ treated groups, further analyses suggested that there were more AEs attributed to other organ system that were not included in the categorized meta-analyses. Additionally, meta-regression analyses revealed that total AEs was affected by dosage for the CQ group. Conclusions: Taken together, we found that participants taking either CQ or HCQ have more AEs than participants taking placebo. Precautionary measures should be taken when using these drugs to treat COVID-19. : medRxiv preprint Data Collection and Outcome MeasuresBibliographic details and abstracts of all citations retrieved by the literature search were downloaded to Endnotes X9. All studies were screened and evaluated by two independent reviewers (LR, PNT), which were then checked by a third reviewer (SY). Discrepancies were resolved by discussion in group conferences. Completed data were then thoroughly checked by two additional reviewers (WX, JLO). Data including first author, year of publication, trial design, All rights reserved. No reuse allowed without permission.was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. : medRxiv preprint country where studies took place, purpose of treatment, trial duration, dosage regimen, outcomes and AEs were extracted using a standardized...

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Section: Discussionmentioning

confidence: 99%

Assessment of Hydroxychloroquine and Chloroquine Safety Profiles – A Systematic Review and Meta-Analysis

Ren

Overton

et al. 2020

Preprint

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“…Two studies described significant QT prolongation in 10 of 95 treated patients, either resulting in an QT increase to over 500 ms or discontinuation of the HCQ/AZ treatment, illustrating the A c c e p t e d M a n u s c r i p t high risk for clinically relevant arrhythmias for this treatment [15,16]. In addition, several case reports of QT prolongation related to hydroxychloroquine have also been published [17][18][19][20].…”

Section: Harmsmentioning

confidence: 99%

Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (April 2020)

Bhimraj

Morgan

Shumaker

et al. 2020

Clinical Infectious Diseases

966

1,045

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Background: There are many pharmacologic therapies that are being used or considered for treatment of COVID-19. There is a need for frequently updated practice guidelines on their use, based on critical evaluation of rapidly emerging literature. Objective: Develop evidence-based rapid guidelines intended to support patients, clinicians and other health-care professionals in their decisions about treatment and management of patients with COVID-19. Methods: IDSA formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise. Process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Results: The IDSA guideline panel agreed on 7 treatment recommendations and provided narrative summaries of other treatments undergoing evaluations. Conclusions:The panel expressed the overarching goal that patients be recruited into ongoing trials, which would provide much needed evidence on the efficacy and safety of various therapies for COVID-19, given that we could not make a determination whether the benefits outweigh harms for most treatments.

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“…Both drugs are listed as definite causes of torsade de pointes at crediblemeds.org. There are occasional case reports of hydroxychloroquine prolonging the QT interval and provoking torsade de pointes [1][2][3][4] when used to treat systemic lupus erythematosus. Antimalarial prophylactic drugs, such as hydroxychloroquine, are believed to act on the entry and post-entry stages of SARS-CoV (severe acute respiratory syndrome-associated coronavirus) and SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection, likely via effects on endosomal pH and the resulting under-glycosylation of angiotensinconverting enzyme 2 receptors that are required for viral entry.…”

mentioning

confidence: 99%

Considerations for Drug Interactions on QTc in Exploratory COVID-19 Treatment

et al. 2020

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Suspected Hydroxychloroquine-Associated QT-Interval Prolongation in a Patient With Systemic Lupus Erythematosus

Cited by 81 publications

References 14 publications

Assessment of Hydroxychloroquine and Chloroquine Safety Profiles – A Systematic Review and Meta-Analysis

Assessment of Hydroxychloroquine and Chloroquine Safety Profiles – A Systematic Review and Meta-Analysis

Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (April 2020)

Considerations for Drug Interactions on QTc in Exploratory COVID-19 Treatment

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