Sinkeler F S, Berger F A, Muntinga H J, Jansen M M P M
Department of Clinical Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, The Netherlands.
Neth Heart J. 2020 Jul;28(7-8):418-423. doi: 10.1007/s12471-020-01462-6.
Chloroquine, a quinolone antimalarial drug, is known to potentially inhibit pH-dependent viral replication of the SARS-CoV‑2 infection. Therefore, chloroquine is considered as a treatment option for coronavirus disease 2019 (COVID-19). Chloroquine is known for prolonging the QT interval, but limited data are available on the extent of this QT-prolonging effect.
To assess the QTc-prolonging potential of chloroquine in COVID-19 patients and to evaluate whether this prolongation increases with the cumulative dose of chloroquine and is associated with the peak plasma concentration of chloroquine. Furthermore, the number of patients who prematurely discontinued treatment or had an adjustment in dose due to QTc-interval prolongation was established.
A retrospective, observational study was performed in patients aged over 18 years, hospitalised for a suspected or proven infection with COVID-19, and therefore treated with chloroquine, with a baseline electrocardiogram (ECG) performed prior to the start of treatment and at least one ECG after starting the treatment.
In total, 397 patients were included. The mean increase in QTc interval throughout the treatment with chloroquine was 33 ms. Nineteen out of 344 patients unnecessarily had their treatment prematurely discontinued or adjusted due to a prolonged QTc interval based on the computerised interpretation of the ECG.
Chloroquine treatment in COVID-19 patients gradually increased the QTc interval. Due to a significant number of overestimated QTc intervals by computer analysis, it is advisable to measure the QTc interval manually before adjusting the dose or withdrawing this potentially beneficial medication.
氯喹是一种喹啉类抗疟药物，已知其可能抑制严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染中依赖pH值的病毒复制。因此，氯喹被视为2019冠状病毒病（COVID-19）的一种治疗选择。氯喹以延长QT间期而闻名，但关于这种QT间期延长效应的程度，可用数据有限。
评估氯喹对COVID-19患者QTc间期的延长潜力，并评估这种延长是否随氯喹累积剂量增加而增加，以及是否与氯喹的血浆峰值浓度相关。此外，确定因QTc间期延长而提前停药或调整剂量的患者数量。
对18岁以上因疑似或确诊感染COVID-19而住院并接受氯喹治疗的患者进行了一项回顾性观察研究，在治疗开始前进行基线心电图（ECG）检查，并在开始治疗后至少进行一次ECG检查。
共纳入397例患者。在整个氯喹治疗期间，QTc间期的平均增加为33毫秒。在344例患者中，有19例因基于ECG计算机解读的QTc间期延长而不必要地提前停药或调整了治疗方案。
COVID-19患者接受氯喹治疗会使QTc间期逐渐增加。由于计算机分析对QTc间期的高估数量较多，建议在调整剂量或停用这种可能有益的药物之前手动测量QTc间期。
