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Hydroxychloroquine cardiotoxicity: a case-control study comparing patients with COVID-19 and patients with systemic lupus erythematosus

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

 

  1. Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit Sapienza University of Rome, Italy.
  2. Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit Sapienza University of Rome, Italy. francescaromana.spinelli@uniroma1.it
  3. Dipartimento di Scienze Cardiovascolari e Respiratorie, Sapienza University of Rome, Italy.
  4. Dipartimento di Sanità Pubblica e Malattie infettive, Sapienza University of Rome, Italy.
  5. Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit Sapienza University of Rome, Italy.
  6. Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit Sapienza University of Rome, Italy.
  7. Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit Sapienza University of Rome, Italy.
  8. Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit Sapienza University of Rome, Italy.
  9. Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit Sapienza University of Rome, Italy.
  10. Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit Sapienza University of Rome, Italy.
  11. Dipartimento di Sanità Pubblica e Malattie infettive, Sapienza University of Rome, Italy.
  12. Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Rheumatology Unit Sapienza University of Rome, Italy.

CER14434
2022 Vol.40, N°5
PI 0890, PF 0896
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PMID: 35383554 [PubMed]

Received: 18/01/2021
Accepted : 12/04/2021
In Press: 30/03/2022
Published: 11/05/2022

Abstract

OBJECTIVES:
Antimalarials have been associated with QT prolongation in COVID-19 patients but are generally safe in systemic lupus erythematosus (SLE).We compared the prevalence of QTc prolongation between COVID-19 and SLE patients treated with hydroxychloroquine (HCQ).
METHODS:
We included patients with SARS-CoV-2 infection confirmed by nasopharyngeal swab and patients taking HCQ for SLE. A prolonged QTc was defined as an increase in QTc intervals >60 ms (compared with baseline) or as a QTc of ≥500 ms. We performed the univariate and multivariate logistic regression to investigate the risk factors for QTc prolongation in COVID-19 patients.
RESULTS:
We enrolled 58 COVID-19 patients (median age 70.5 years, IQR 25), grouped into group A (patients with HCQ) group B (patients with HCQ + azithromycin) and group C (not received either drug). Fifty (26%) COVID-19 patients presented a QTc prolongation (12 QTc≥500 ms, 3 patients ΔQTc>60 ms). We did not find any differences in QTc prolongation among the three treatment groups. Baseline QTc (OR 111.5) and D-dimer (OR 78.3) were independently associated to QTc prolongation. Compared to the 50 SLE patients (median age 38.5 years, IQR 22), chronically treated with HCQ, COVID-19 patients showed significantly longer QTc (p<0.001).
CONCLUSIONS:
This is the first study demonstrating that, unlike COVID-19 patients, patients with SLE are not susceptible to HCQ-induced long QT syndrome and arrhythmia. The combined arrhythmogenic effect of SARS-CoV-2 infection and HCQ could account for the excess of QTc prolongation and fatal arrhythmias described in patients with COVID-19.

DOI: https://doi.org/10.55563/clinexprheumatol/7ullgb

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