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Furtado RHM, Barros E Silva PGM, Fonseca HAR, Serpa-Neto A, Correa TD, Guimarães HP, Pereira AJ, Olivato GB, Zampieri FG, Lisboa T, Junqueira DLM, Lapa MG, Monfardini F, Damiani LP, Echenique LS, Gebara OE, Hoffman Filho CR, Polanczyk CA, Rohde LE, Amazonas R, Machado FR, Avezum A, Azevedo LCP, Veiga VC, Rosa RG, Lopes RD, Cavalcanti AB, Berwanger O. Cardiovascular Safety of Azithromycin in Patients Hospitalized With COVID-19: A Prespecified Pooled Analysis of the COALITION I and COALITION II Randomized Clinical Trials. Am J Cardiol 2024; 214:18-24. [PMID: 38104755 DOI: 10.1016/j.amjcard.2023.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
The cardiovascular safety from azithromycin in the treatment of several infectious diseases has been challenged. In this prespecified pooled analysis of 2 multicenter randomized clinical trials, we aimed to assess whether the use of azithromycin might lead to corrected QT (QTc) interval prolongation or clinically relevant ventricular arrhythmias. In the COALITION COVID Brazil I trial, 667 patients admitted with moderate COVID-19 were randomly allocated to hydroxychloroquine, hydroxychloroquine plus azithromycin, or standard of care. In the COALITION COVID Brazil II trial, 447 patients with severe COVID-19 were randomly allocated to hydroxychloroquine alone versus hydroxychloroquine plus azithromycin. The principal end point for the present analysis was the composite of death, resuscitated cardiac arrest, or ventricular arrhythmias. The addition of azithromycin to hydroxychloroquine did not result in any prolongation of the QTc interval (425.8 ± 3.6 ms vs 427.9 ± 3.9 ms, respectively, mean difference -2.1 ms, 95% confidence interval -12.5 to 8.4 ms, p = 0.70). The combination of azithromycin plus hydroxychloroquine compared with hydroxychloroquine alone did not result in increased risk of the primary end point (proportion of patients with events at 15 days 17.2% vs 16.0%, respectively, hazard ratio 1.08, 95% confidence interval 0.78 to 1.49, p = 0.65). In conclusion, in patients hospitalized with COVID-19 already receiving standard-of-care management (including hydroxychloroquine), the addition of azithromycin did not result in the prolongation of the QTc interval or increase in cardiovascular adverse events. Because azithromycin is among the most commonly prescribed antimicrobial agents, our results may inform clinical practice. Clinical Trial Registration: NCT04322123, NCT04321278.
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Affiliation(s)
- Remo H M Furtado
- Brazilian Clinical Research Institute, São Paulo, Brazil; Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | | | | | - Ary Serpa-Neto
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil; Australian and New Zealand Intensive Care Research Center (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Adriano J Pereira
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil
| | | | | | - Thiago Lisboa
- HCor Research Institute, São Paulo, Brazil; Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil
| | | | - Maura G Lapa
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Lucas P Damiani
- Brazilian Clinical Research Institute, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Leandro S Echenique
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Hospital Moriah, São Paulo, Brazil
| | | | | | - Carisi A Polanczyk
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Luis E Rohde
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Flávia R Machado
- Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil; Department of Anesthesiology, Pain and Intensive Care Medicine; Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Luciano C P Azevedo
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Hospital Sírio Libanês Research and Education Institute, São Paulo, Brazil
| | - Viviane C Veiga
- Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil; BP A Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | - Regis G Rosa
- Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil; Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renato D Lopes
- Brazilian Clinical Research Institute, São Paulo, Brazil; Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | | | - Otavio Berwanger
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Imperial College London, London, United Kingdom; The George Institute for Global Health, London, United Kingdom
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