The risk of QTc-interval prolongation in COVID-19 patients treated with chloroquine

Abstract

Background Chloroquine, a quinolone antimalarial drug, is known to potentially inhibit pH-dependent viral replication of the SARS-CoV-2 infection. Therefore, chloroquine is considered as a treatment option for coronavirus disease 2019 (COVID-19). Chloroquine is known for prolonging the QT interval, but limited data are available on the extent of this QT-prolonging effect. Objective To assess the QTc-prolonging potential of chloroquine in COVID-19 patients and to evaluate whether this prolongation increases with the cumulative dose of chloroquine and is associated with the peak plasma concentration of chloroquine. Furthermore, the number of patients who prematurely discontinued treatment or had an adjustment in dose due to QTc-interval prolongation was established. Methods A retrospective, observational study was performed in patients aged over 18 years, hospitalised for a suspected or proven infection with COVID-19, and therefore treated with chloroquine, with a baseline electrocardiogram (ECG) performed prior to the start of treatment and at least one ECG after starting the treatment. Results In total, 397 patients were included. The mean increase in QTc interval throughout the treat

The Netherlands Heart Journal: special issue on COVID-19

“…The article of Sinkeler et al. [ 3 ] draws the same conclusion from an even larger cohort of COVID-19 patients, whilst adding that since the computer-based algorithm for calculating the QTc interval seems to overestimate the actual QTc, manual QTc measurements are advisable before adjusting chloroquine doses or even withdrawing chloroquine treatment. Reviewing this, Wilde and Offerhaus [ 4 ] comment on the use of hydroxychloroquine and chloroquine and refer to them as ‘the president’s drug’.…”

Dutch cardiology residents and the COVID-19 pandemic: Every little thing counts in a crisis

“…Moreover, cardiology residents have proven to be essential in the often ad hoc created multidisciplinary teams of doctors given their advanced knowledge of haemodynamics and interpretation of side effects of medications (e.g. chloroquine) on cardiac conduction and function [ 5 , 6 ].…”

The ‘president’s drug’

“…Finally, genetic factors particularly present in black African individuals may predispose them to accumulation of all these effects [22]. The hypothesis that QT-prolonging factors, as mentioned above, are imperative in COVID-19 patients is underscored by the fact that the baseline mean QTc interval in COVID-19 patients as presented in both Dutch studies [15,16] is much longer (in the range 440-450 ms) than in studies with volunteers (400-410 ms) [6].…”

“…This indicates a decrease in conduction, which is also potentially pro-arrhythmic by favouring re-entrant circuits. In the study by Sinkeler et al 397 hospitalised patients were treated with CQ (same dosage regimen) [16]. After 24-72 h the QTc had increased by 20 ms (±39 ms, mean ± SD); a second ECG in a subset of patients revealed a further increase to 33 ± 53 ms.…”