Adverse Effects Associated With the Use of Antimalarials During The COVID-19 Pandemic in a Tertiary Care Center in Mexico City

Frontiers in Pharmacology

Antonio Olivas-Martinez¹  Clemente Barrón-Magdaleno²  Jorge Carlos Oseguera-Moguel²  Aldo C Cázares-Diazleal²  Joel Dorantes-García²  Karla María Tamez-Torres³  José Sifuentes-Osornio³  Bernardo Alfonso Martínez-Guerra³  Carla Marina Román-Montes³  Alfredo Ponce-de-León-Garduño³  María Fernanda González-Lara³  Daniel Azamar-Llamas⁴  José Víctor Jiménez⁴  José Luis Cárdenas-Fragoso⁴  Oscar Arturo Lozano-Cruz⁴  Sergio Rodríguez-Rodríguez⁴  Alfonso Gulias-Herrero⁴  Edgar Ortiz-Brizuela⁴  David Kershenobich-Stalnikowitz⁵ 

[1] Department of Biostatistics, University of WA, Seattle, WA, United States;Department of Cardiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico;Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico;Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico;General Director’s Office, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico;

关键词: hydroxychloroquine;    chloroquine;    COVID-19;    arrythmia;    adverse-effects;    antimalarial;   

DOI  :  10.3389/fphar.2021.668678

来源: DOAJ

【 摘 要 】

Background: Antimalarial drugs were widely used as experimental therapies against COVID-19 in the initial stages of the pandemic. Despite multiple randomized controlled trials demonstrating unfavorable outcomes in both efficacy and adverse effects, antimalarial drugs are still prescribed in developing countries, especially in those experiencing recurrent COVID-19 crises (India and Brazil). Therefore, real-life experience and pharmacovigilance studies describing the use and side effects of antimalarials for COVID-19 in developing countries are still relevant.Objective: To describe the adverse effects associated with the use of antimalarial drugs in hospitalized patients with COVID-19 pneumonia at a reference center in Mexico City.Methods: We integrated a retrospective cohort with all adult patients hospitalized for COVID-19 pneumonia from March 13th, 2020, to May 17th, 2020. We compared the baseline characteristics (demographic and clinical) and the adverse effects between the groups of patients treated with and without antimalarial drugs. The mortality analysis was performed in 491 patients who received optimal care and were not transferred to other institutions (210 from the antimalarial group and 281 from the other group).Results: We included 626 patients from whom 38% (n = 235) received an antimalarial drug. The mean age was 51.2 ± 13.6 years, and 64% were males. At baseline, compared with the group treated with antimalarials, the group that did not receive antimalarials had more dyspnea (82 vs. 73%, p = 0.017) and cyanosis (5.3 vs. 0.9%, p = 0.009), higher respiratory rate (median of 28 vs. 24 bpm, p < 0.001), and lower oxygen saturation (median of 83 vs. 87%, p < 0.001). In the group treated with antimalarials, 120 patients had two EKG evaluations, from whom 12% (n = 16) prolonged their QTc from baseline in more than 50 ms, and six developed a ventricular arrhythmia. Regarding the trajectories of the liver function tests over time, no significant differences were found for the change in the mean value per day between the two groups. Among patients who received optimal care, the mortality was 16% (33/210) in those treated with antimalarials and 15% (41/281) in those not receiving antimalarials (RR 1.08, 95% 0.75–1.64, and adjusted RR 1.12, 95% CI 0.69–1.82).Conclusion: The adverse events in patients with COVID-19 treated with antimalarials were similar to those who did not receive antimalarials at institutions with rigorous pharmacological surveillance. However, they do not improve survival in patients who receive optimal medical care.

【 授权许可】

Unknown