SynthesisPharmacoepidemiology and drug safety2021
QTc prolongation in COVID-19 patients treated with hydroxychloroquine, chloroquine, azithromycin, or lopinavir/ritonavir: A systematic review and meta-analysis.
Synthesis in Pharmacoepidemiology and drug safety, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Potential limitations in systematic review studies assessing the effect of the main intervention for treatment/therapy of COVID-19 patients: An overview.Frontiers in medicine · 2022Pooled it
- QTc prolongation in COVID-19 patients treated with hydroxychloroquine, chloroquine, azithromycin, or lopinavir/ritonavir: A systematic review and meta-analysis.Pharmacoepidemiology and drug safety · 2021Pooled it
- Comparative Effectiveness of Azithromycin Versus Doxycycline in Hospitalized Patients With Community-Acquired Pneumonia Treated With Beta-Lactams: A Multicenter Matched Cohort Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Temporal variations in QTc interval during and after COVID-19 infection: a retrospective study.BMC cardiovascular disorders · 2024Article
- QTc Prolongation to Predict Mortality in Patients Admitted with COVID-19 Infection: An Observational Study.Current vascular pharmacology · 2024Observational
- Real-Life Data on Hydroxychloroquine or Chloroquine with or Without Azithromycin in COVID-19 Patients: A Retrospective Analysis in Brazil.Arquivos brasileiros de cardiologia · 2023Article
- The potential role of SARS-CoV-2 infection in acute coronary syndrome and type 2 myocardial infarction (T2MI): Intertwining spread.Immunity, inflammation and disease · 2023Review
- Article
- Anti-malarial drugs: Mechanisms underlying their proarrhythmic effects.British journal of pharmacology · 2022Review
- COVID-19 and the heart.World journal of clinical cases · 2022Review
- Early Alterations of QTc in Patients with COVID-19 Treated with Hydroxychloroquine or Chloroquine in Libreville, Gabon.Clinics and practice · 2022Article
- Prescription Patterns of Drugs Given to Hospitalized COVID-19 Patients: A Cross-Sectional Study in Colombia.Antibiotics (Basel, Switzerland) · 2022Article
- Changes in the Profile of Antibiotic Prescriptions by Dentists in Brazil during the Pandemic.International journal of dentistry · 2022Article
- Consumption Trends of Antibiotics in Brazil During the COVID-19 Pandemic.Frontiers in pharmacology · 2022Article
- Drug Prescriptions in the Outpatient Management of COVID-19: Evidence-Based Recommendations Versus Real Practice.Frontiers in pharmacology · 2022Article
- Interleukin-6 Elevation Is a Key Pathogenic Factor Underlying COVID-19-Associated Heart Rate-Corrected QT Interval Prolongation.Frontiers in cardiovascular medicine · 2022Article
- Direct cardiovascular complications and indirect collateral damage during the COVID-19 pandemic : A review.Wiener klinische Wochenschrift · 2021Review
- An update on drugs with therapeutic potential for SARS-CoV-2 (COVID-19) treatment.Drug resistance updates : reviews and commentaries in antimicrobial and anticancer chemotherapy · 2021Review
- QT interval and repolarization dispersion changes during the administration of hydroxychloroquine/chloroquine with/without azithromycin in early COVID 19 pandemic: A prospective observational study from two academic hospitals in Indonesia.Journal of arrhythmia · 2021Article
- Use of Antioxidants for the Neuro-Therapeutic Management of COVID-19.Antioxidants (Basel, Switzerland) · 2021Review
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 2 countries.
Funding
Abstract
purposeHydroxychloroquine, chloroquine, azithromycin, and lopinavir/ritonavir are drugs that were used for the treatment of coronavirus disease 2019 (COVID-19) during the early pandemic period. It is well-known that these agents can prolong the QTc interval and potentially induce Torsades de Pointes (TdP). We aim to assess the prevalence and risk of QTc prolongation and arrhythmic events in COVID-19 patients treated with these drugs.
methodsWe searched electronic databases from inception to September 30, 2020 for studies reporting peak QTc ≥500 ms, peak QTc change ≥60 ms, peak QTc interval, peak change of QTc interval, ventricular arrhythmias, TdP, sudden cardiac death, or atrioventricular block (AVB). All meta-analyses were conducted using a random-effects model.
resultsForty-seven studies (three case series, 35 cohorts, and nine randomized controlled trials [RCTs]) involving 13 087 patients were included. The pooled prevalence of peak QTc ≥500 ms was 9% (95% confidence interval [95%CI], 3%-18%) and 8% (95%CI, 3%-14%) in patients who received hydroxychloroquine/chloroquine alone or in combination with azithromycin, respectively. Likewise, the use of hydroxychloroquine (risk ratio [RR], 2.68; 95%CI, 1.56-4.60) and hydroxychloroquine + azithromycin (RR, 3.28; 95%CI, 1.16-9.30) was associated with an increased risk of QTc prolongation compared to no treatment. Ventricular arrhythmias, TdP, sudden cardiac death, and AVB were reported in <1% of patients across treatment groups. The only two studies that reported individual data of lopinavir/ritonavir found no cases of QTc prolongation.
conclusionsCOVID-19 patients treated with hydroxychloroquine/chloroquine with or without azithromycin had a relatively high prevalence and risk of QTc prolongation. However, the prevalence of arrhythmic events was very low, probably due to underreporting. The limited information about lopinavir/ritonavir showed that it does not prolong the QTc interval.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.