Background: Chloroquine or hydroxychloroquine (chloroquine) plus azithromycin is considered as therapy for COVID-19. With benefit evaluations underway, safety concerns due to potential additive effects on QTc prolongation should be addressed.
Objective: We compared risk of cardiac adverse events between combinations of chloroquine and azithromycin and chloroquine and amoxicillin.
Methods: We conducted a retrospective cohort study using the IBM MarketScan Commercial Claims and Medicare Supplemental Databases, 2005-2018. We included autoimmune disease patients aged ≥18 years initiating azithromycin or amoxicillin for ≥5 days during chloroquine treatment. Patients had continuous insurance coverage ≥6 months before combination use until 5 days thereafter or inpatient death. Two outcomes were sudden cardiac arrest/ventricular arrhythmias (SCA/VA) and cardiac symptoms. We followed patients for up to 5 days to estimate hazard ratios (HR). Covariates were adjusted using stabilized inverse probability treatment weighting.
Results: We identified two SVC/VA events among >145,000 combination users. The adjusted incidence of cardiac symptoms among azithromycin and amoxicillin users was 276 vs 254 per 10,000 person-years with an adjusted HR of 1.10 (95%CI, 0.62-1.95).
Conclusion: Combination use of chloroquine and azithromycin at routine doses did not show pronounced increases in arrhythmias in this real-world population, though small sample size and outcome rates limit conclusions.
Keywords: CI, confidence interval; COPD, Chronic obstructive pulmonary disease; COVID19; Cardiac events; Chloroquine; FDA, U.S. Food & Drug Administration; HR, hazard ratio; Hydroxychloroquine; QTc prolongation; SCA/VA, sudden cardiac arrest and ventricular arrhythmias; SIPTW, Standardized inverse probability treatment weighting.
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