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Cardiac toxicity of chloroquine or hydroxychloroquine in patients With COVID-19: A systematic review and meta-regression analysis

Tleyjeh, Imad M., Kashour, Zakariya, AlDosary, Oweida, Riaz, Muhammad, Tlayjeh, Haytham, Garbati, Musa A., Tleyjeh, Rana, Al-Mallah, Mouaz H., Sohail, M. Rizwan, Gerberi, Dana, Bin Abdulhak, Aref A., Giudicessi, John R., Ackerman, Michael J. and Kashour, Tarek 2021. Cardiac toxicity of chloroquine or hydroxychloroquine in patients With COVID-19: A systematic review and meta-regression analysis. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 5 (1) , pp. 137-150. 10.1016/j.mayocpiqo.2020.10.005

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Objective To systematically review the literature and to estimate the risk of chloroquine (CQ) and hydroxychloroquine (HCQ) cardiac toxicity in patients with coronavirus disease 2019 (COVID-19). Methods We searched multiple data sources including PubMed/MEDLINE, Ovid Embase, Ovid EBM Reviews, Scopus, and Web of Science and from November 2019 through May 27, 2020. We included studies that enrolled patients with COVID-19 treated with CQ or HCQ, with or without azithromycin, and reported on cardiac toxic effects. We performed a meta-analysis using the arcsine transformation of the different incidences. Results A total of 19 studies with a total of 5652 patients were included. The pooled incidence of torsades de pointes arrhythmia, ventricular tachycardia, or cardiac arrest was 3 per 1000 (95% CI, 0-21; I2=96%) in 18 studies with 3725 patients. Among 13 studies of 4334 patients, the pooled incidence of discontinuation of CQ or HCQ due to prolonged QTc or arrhythmias was 5% (95% CI, 1-11; I2=98%). The pooled incidence of change in QTc from baseline of 60 milliseconds or more or QTc of 500 milliseconds or more was 9% (95% CI, 3-17; I2=97%). Mean or median age, coronary artery disease, hypertension, diabetes, concomitant QT-prolonging medications, intensive care unit admission, and severity of illness in the study populations explained between-studies heterogeneity. Conclusion Treatment of patients with COVID-19 with CQ or HCQ is associated with an important risk of drug-induced QT prolongation and relatively higher incidence of torsades de pointes, ventricular tachycardia, or cardiac arrest. Therefore, these agents should not be used routinely in the management of COVID-19 disease. Patients with COVID-19 who are treated with antimalarials for other indications should be adequately monitored.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
ISSN: 2542-4548
Last Modified: 21 Dec 2021 13:53

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