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. 2020 Apr 30;S1551-7411(20)30468-X.
doi: 10.1016/j.sapharm.2020.04.031. Online ahead of print.

An Evaluation of Co-Use of Chloroquine or Hydroxychloroquine Plus Azithromycin on Cardiac Outcomes: A Pharmacoepidemiological Study to Inform Use During the COVID19 Pandemic

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An Evaluation of Co-Use of Chloroquine or Hydroxychloroquine Plus Azithromycin on Cardiac Outcomes: A Pharmacoepidemiological Study to Inform Use During the COVID19 Pandemic

Scott M Vouri et al. Res Social Adm Pharm. .
Free PMC article

Abstract

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: COVID19; Cardiac events; Chloroquine; Hydroxychloroquine; QTc prolongation.

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