.: ORİJİNAL ARAŞTIRMA
Impact of Adding Favipiravir to Hydroxychloroquine and Azithromycin Treatment on QTc Interval in COVID-19
Hidroksiklorokin ve Azitromisin Tedavisine Favipiravirin Eklenmesinin COVID-19'da QTc Aralığı Üzerindeki Etkisi
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(1):15-21
doi: 10.5336/cardiosci.2020-80082
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: The Coronavirus disease-2019 (COVID-19) pandemic has caused the death of many people worldwide. Treatment protocol had to be developed as soon as possible so drug combinations, whose reliability has not been fully disclosed, have started to be used. In this study, we aimed to evaluate the effect of azithromycin (AZT), hydroxychloroquine (HCQ), and favipiravir (FVR) combination on the corrected QT (QTc) interval. Material and Methods: Eighty-four consecutive COVID 19 patients were enrolled in the study. All patients received AZT and HCQ, however, FVR was added to the combination in 32 patients with severe pneumonia at the beginning. ECG characteristics of all patients before treatment and on the fifth day of treatment were compared. Results: There was no significant difference between the HCQ+AZT group (n=52) and HCQ+AZT+FVR groups (n=32) in terms of baseline clinical characteristics. QTc interval significantly prolonged on the fifth day of treatment in the HCQ+AZT group (413,75±30,13; 440,27±36,11 p 500 ms was detected after the treatment, four patients in the HCQ+AZT+FVR group and three patients in the HCQ+AZT group. Conclusion: We observed that FVR caused more prolongation in the QTc interval when used with the combination of HCQ+AZT. We recommend that patients who receive this treatment be monitored more closely for QTc.
Keywords: Azithromycin; COVID-19; favipiravir; hydroxychloroquine; QT interval
Objective: The Coronavirus disease-2019 (COVID-19) pandemic has caused the death of many people worldwide. Treatment protocol had to be developed as soon as possible so drug combinations, whose reliability has not been fully disclosed, have started to be used. In this study, we aimed to evaluate the effect of azithromycin (AZT), hydroxychloroquine (HCQ), and favipiravir (FVR) combination on the corrected QT (QTc) interval. Material and Methods: Eighty-four consecutive COVID 19 patients were enrolled in the study. All patients received AZT and HCQ, however, FVR was added to the combination in 32 patients with severe pneumonia at the beginning. ECG characteristics of all patients before treatment and on the fifth day of treatment were compared. Results: There was no significant difference between the HCQ+AZT group (n=52) and HCQ+AZT+FVR groups (n=32) in terms of baseline clinical characteristics. QTc interval significantly prolonged on the fifth day of treatment in the HCQ+AZT group (413,75±30,13; 440,27±36,11 p 500 ms was detected after the treatment, four patients in the HCQ+AZT+FVR group and three patients in the HCQ+AZT group. Conclusion: We observed that FVR caused more prolongation in the QTc interval when used with the combination of HCQ+AZT. We recommend that patients who receive this treatment be monitored more closely for QTc.
Keywords: Azithromycin; COVID-19; favipiravir; hydroxychloroquine; QT interval
ÖZET
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)], dünya çapında birçok ölüme neden olan bir pandemiye yol açtı. Tedavi protokolünün bir an önce geliştirilmesi gerektiğinden, güvenilirliği tam olarak tanımlanmamış ilaç kombinasyonlarının kullanılmasına neden oldu. Bu çalışmada, azitromisin (AZT), hidroksiklorokin (HCQ) ve favipiravirin (FVR) kombinasyonunda düzeltilmiş QT (QTc) aralığı üzerindeki etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Çalışmaya, 84 ardışık COVID-19 hastası dâhil edildi. Tüm hastalara AZT ve HCQ verildi, ancak başlangıçta şiddetli pnömonili 32 hastada kombinasyona FVR eklendi. Tüm hastaların tedavi öncesi ve tedavinin 5. gününde elektrokardiyografi özellikleri karşılaştırıldı. Bulgular: HCQ+AZT grubu (n=52) ile HCQ+AZT+FVR grupları (n=32) arasında başlangıç klinik özellikleri açısından anlamlı fark yoktu. QTc aralığı, tedavinin 5. gününde HCQ+AZT grubunda (413,75±30,13 msn; 440,27±36,11 msn p500 msn ölçüldü, bu hastaların 4'ü HCQ+AZT+FVR grubunda ve 3'ü HCQ+AZT grubundaydı. Sonuç: Çalışmamızda, HCQ+AZT kombinasyonu ile kullanıldığında FVR'nin, QTc aralığında daha fazla uzamaya neden olduğunu gözlemledik. Bu tedaviyi alan hastaların, QTc için daha yakından izlenmesi gerektiği kanaatindeyiz.
Anahtar Kelimeler: Azitromisin; COVID-19; favipiravir; hidroksiklorokin; QTc aralığı
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)], dünya çapında birçok ölüme neden olan bir pandemiye yol açtı. Tedavi protokolünün bir an önce geliştirilmesi gerektiğinden, güvenilirliği tam olarak tanımlanmamış ilaç kombinasyonlarının kullanılmasına neden oldu. Bu çalışmada, azitromisin (AZT), hidroksiklorokin (HCQ) ve favipiravirin (FVR) kombinasyonunda düzeltilmiş QT (QTc) aralığı üzerindeki etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Çalışmaya, 84 ardışık COVID-19 hastası dâhil edildi. Tüm hastalara AZT ve HCQ verildi, ancak başlangıçta şiddetli pnömonili 32 hastada kombinasyona FVR eklendi. Tüm hastaların tedavi öncesi ve tedavinin 5. gününde elektrokardiyografi özellikleri karşılaştırıldı. Bulgular: HCQ+AZT grubu (n=52) ile HCQ+AZT+FVR grupları (n=32) arasında başlangıç klinik özellikleri açısından anlamlı fark yoktu. QTc aralığı, tedavinin 5. gününde HCQ+AZT grubunda (413,75±30,13 msn; 440,27±36,11 msn p500 msn ölçüldü, bu hastaların 4'ü HCQ+AZT+FVR grubunda ve 3'ü HCQ+AZT grubundaydı. Sonuç: Çalışmamızda, HCQ+AZT kombinasyonu ile kullanıldığında FVR'nin, QTc aralığında daha fazla uzamaya neden olduğunu gözlemledik. Bu tedaviyi alan hastaların, QTc için daha yakından izlenmesi gerektiği kanaatindeyiz.
Anahtar Kelimeler: Azitromisin; COVID-19; favipiravir; hidroksiklorokin; QTc aralığı
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