Abstract
Background
In the battle against the SARS-CoV‑2 pandemic, chloroquine has emerged as a new potential therapeutic option for the treatment of infected patients. A safety consideration for the application of chloroquine is its QTc-prolonging potential. Thus far, no data are available on the QTc-prolonging potential of chloroquine in COVID-19 patients.
Objective
To assess the degree of chloroquine-induced QTc prolongation in hospitalised COVID-19 patients.
Methods
A baseline electrocardiogram (ECG) and ECGs recorded during chloroquine treatment were retrospectively collected in patients suspected of having COVID-19. The QTc interval was calculated by computerised and manual interpretation. Baseline and follow-up QTc intervals were compared using the paired samples t-test.
Results
A total of 95 patients had a baseline ECG recording and at least one ECG recording during chloroquine therapy. Chloroquine treatment resulted in a mean QTc prolongation of 35 ms (95% CI 28–43 ms) using computerised interpretation and 34 ms (95% CI 25–43 ms) using manual interpretation. No torsade de pointes was observed during chloroquine treatment. After manual review, 22 patients (23%) had a QTc interval exceeding 500 ms during chloroquine treatment. None of these patients had a prolonged QTc interval prior to the initiation of chloroquine treatment.
Conclusions
Chloroquine significantly prolongs the QTc interval in a clinically relevant matter. This highlights the need for ECG monitoring when prescribing chloroquine to COVID-19 patients.
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Details
1 St. Antonius Hospital, Department of Clinical Pharmacy, Utrecht/Nieuwegein, The Netherlands (GRID:grid.415960.f) (ISNI:0000 0004 0622 1269)
2 St. Antonius Hospital, Department of Cardiology, Nieuwegein, The Netherlands (GRID:grid.415960.f) (ISNI:0000 0004 0622 1269)
3 St. Antonius Hospital, Department of Clinical Pharmacy, Utrecht/Nieuwegein, The Netherlands (GRID:grid.415960.f) (ISNI:0000 0004 0622 1269); Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht, The Netherlands (GRID:grid.5477.1) (ISNI:0000000120346234)