key: cord-268519-t15yvy5s
authors: Pothen, Lucie; Yildiz, Halil; De Greef, Julien; Penaloza, Andrea; Beauloye, Christophe; Belkhir, Leila; Yombi, Jean Cyr
title: Safety use of hydroxychloroquine and its combination with azithromycin in the context of Sars-CoV-2 outbreak: Clinical experience in a Belgian tertiary center
date: 2020-06-12
journal: Travel Med Infect Dis
DOI: 10.1016/j.tmaid.2020.101788
sha: 
doc_id: 268519
cord_uid: t15yvy5s

nan

Despite some encouraging preliminary clinical data (2,3), major concerns have been raised about the use of HCQ to treat COVID-19 (5), particularly regarding potential cardiac toxicity (i.e. QTc increase and risk of torsade de pointe). Because HCQ has been safely used for many years for various indications (e.a. connective tissue diseases) (6), we decided to follow interim Belgian guidance for all eligible patients hospitalized in our COVID-19 wards. Moreover, we were treated by supplementation if present. Repeat ECG was not systematically performed during HCQ treatment, except in case of drug-drug interaction which could potentially increase QTc (see foot note of Table1). The main drug-drug interaction was driven by addition of AZM (n=28). In this group, QTc was controlled at day 2 of combination therapy (n=24). We observed a significant increase in mean QTc, from 418 to 433 msec (p< 0,01 with paired t-test), but none of the patients showed a QTc over 500 msec.

Furthermore, in our entire cohort there were no sudden deaths nor syncope requiring resuscitation or ICU admission. All ICU admissions (n=13) were linked to respiratory failure resulting from COVID-19 pneumonia. One patient on HCQ presented AV nodal reentry tachycardia in parallel with respiratory failure, and was successfully treated with adenosine.

All deaths in our cohort (n= 12) were attributed to COVID-19 infection.

In conclusion, based on our clinical experience, no safety issues were encountered with the use of HCQ for the treatment of COVID-19. In coherence with recent data published here (7), its association with AZM also seems to be safe, despite a significant increase of QTc that should be carefully monitored. The efficacy of HCQ and its combination with azithromycin on COVID-19 infection needs, of course, to be strengthened with further evidence from large randomized clinical trials. However, at this point of the COVID-19 pandemic, we find it relevant to share our clinical experience with this well-known, readily available compound (HCQ) which has limited contraindications and may help in the fight against this outbreak. abdominal pain, diarrhea); "moderate" as clinical (fever and cough) and radiological pneumonia (infiltrates) without hypoxemia; "severe" as clinical and radiological pneumonia with hypoxemia (O 2 saturation < 93%). **other consisted in escitalopram, citalopram, fluconazole, valproate, mirtazapine and olanzapine.

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