Effect of hydroxychloroquine on the cardiac ventricular repolarization: A randomized clinical trial

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  • Boukje C. Eveleens Maarse
  • Claus Graff
  • Kanters, Jørgen K.
  • Michiel J. van Esdonk
  • Michiel J.B. Kemme
  • Aliede E. in 't Veld
  • Manon A.A. Jansen
  • Matthijs Moerland
  • Pim Gal

Aims: Hydroxychloroquine has been suggested as possible treatment for severe acute respiratory syndrome-coronavirus-2. Studies reported an increased risk of QTcF-prolongation after treatment with hydroxychloroquine. The aim of this study was to analyse the concentration-dependent effects of hydroxychloroquine on the ventricular repolarization, including QTcF-duration and T-wave morphology. Methods: Twenty young (≤30 y) and 20 elderly (65–75 y) healthy male subjects were included. Subjects were randomized to receive either a total dose of 2400 mg hydroxychloroquine over 5 days, or placebo (ratio 1:1). Follow-up duration was 28 days. Electrocardiograms (ECGs) were recorded as triplicate at baseline and 4 postdose single recordings, followed by hydroxychloroquine concentration measurements. ECG intervals (RR, QRS, PR, QTcF, J-Tpc, Tp-Te) and T-wave morphology, measured with the morphology combination score, were analysed with a prespecified linear mixed effects concentration–effect model. Results: There were no significant associations between hydroxychloroquine concentrations and ECG characteristics, including RR-, QRS- and QTcF-interval (P =.09,.34,.25). Mean ΔΔQTcF-interval prolongation did not exceed 5 ms and the upper limit of the 90% confidence interval did not exceed 10 ms at the highest measured concentrations (200 ng/mL). There were no associations between hydroxychloroquine concentration and the T-wave morphology (P =.34 for morphology combination score). There was no significant effect of age group on ECG characteristics. Conclusion: In this study, hydroxychloroquine did not affect ventricular repolarization, including the QTcF-interval and T-wave morphology, at plasma concentrations up to 200 ng/mL. Based on this analysis, hydroxychloroquine does not appear to increase the risk of QTcF-induced arrhythmias.

Original languageEnglish
JournalBritish Journal of Clinical Pharmacology
Volume88
Issue number3
Pages (from-to)1054-1062
Number of pages9
ISSN0306-5251
DOIs
Publication statusPublished - Mar 2022

Bibliographical note

Funding Information:
The study was funded by the Centre for Human Drug Research, Leiden, The Netherlands.

Publisher Copyright:
© 2021 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

    Research areas

  • cardiac ventricular repolarization, concentration–effect analysis, electrocardiogram, hydroxychloroquine, QT-interval

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