Abstract 15082: Repolarization Vulnerability is Rarely Observed in COVID-19 Patients With Low Comorbidity Treated With a Combination of Hydroxychloroquine Azithromycin

Abstract

Background: Global pandemic of COVID-19 has attracted a number of proposed treatment therapies. Hydroxychloroquine/Azithromycin (HA) combination has been reported to potentially affect repolarization by prolonging the QTc and causing torsades de pointes (TdP). Methods: We prospectively followed hospitalized patients with PCR confirmed COVID-19. Hydroxychloroquine was administered 400mg twice daily on day 1 and daily for the last 4 days plus daily Azithromycin 250mg. QTc interval was measured via 12 lead ECG prior to initiation of therapy, 3 hours post second dose of hydroxychloroquine, and subsequent daily QTc evaluation via telemetry. Potassium and magnesium were checked daily and replaced accordingly. QTc prolonging medications were discontinued when possible. Results: Sixteen patients were followed for 5 days, 56% were male with average age of 67. Comorbidities were 31% coronary artery disease, 31% diabetes mellitus, 13% congestive heart failure, 69% hypertension, 19% chronic obstructive pulmonary disease, 25% atrial fibrillation, and average BMI of 29. Average Tisdale score was 11/21. Mean QTc prior to HA therapy was 442 ms, 3 hours post second dose 429 ms and on day 5 was 441 ms with a change of (-)3ms compared to prior starting therapy as seen in figures below. Fifteen patients recovered and 1 patient expired. Twenty five percent of patients required ET intubation and mechanical ventilation. Zero patients required stopping of HA therapy. Only 1 patient required 2 extra days of QTc monitoring due to 5th day QTc being 504ms. Conclusion In acutely infected COVID-19 patients with limited comorbidities, repolarization/risk for TdP appears to be low in the presence of HA. With close monitoring and the right patient population, this combination therapy for short term treatment appears to be safe in regards to QTc and the risk for TdP. Although larger published studies have shown repolarization risk, we did not find that to be the case in our relatively healthy population.