French Hospital Stops Hydroxychloroquine Treatment for COVID-19 Patient Over Major Cardiac Risk

A hospital in France has had to stop an experimental treatment using hydroxychloroquine on at least one coronavirus patient after it became a "major risk" to their cardiac health.

The University Hospital Center of Nice (CHU de Nice) is one of many hospitals trialing hydroxychloroquine in COVID-19 patients. It announced it had been selected for the trial on March 22. A statement from the hospital said it was testing four experimental treatments, one of which included hydroxychloroquine. It hoped to establish its effectiveness and side effects of this and the other treatments being tested.

In an interview with the French daily newspaper Nice-Matin, Professor Émile Ferrari, the head of the cardiology department at the Pasteur hospital in Nice, said the side effects had already been identified, with some patients having to stop treatment because of the risk posed.

He said electrocardiogram recordings of patients involved with the trial were being constantly monitored. An ECG measures electrical activity in the heart, and represents this on a graph as a QT interval. Ferrari said these recordings are interpreted and, if anomalies are reported, treatment is stopped.

Asked if this had happened yet, he said: "Yes, from the start of the trial. Thanks to this ECG follow-up, we highlighted the major risks of a very serious accident in a patient, and the treatment was immediately stopped."

The potential cardiac side effects of hydroxychloroquine were highlighted by the Mayo Clinic at the end of March. An article on its website said the drug has the potential to lead to sudden cardiac death in some patients. In a small number of patients it has the potential to lead to a prolonged QTc , which can result in an abnormal heart rhythm.

Hydroxychloroquine, Mayo Clinic said, blocks one of the channels that controls the heart's electrical recharging systems. "This interference increases the possibility that the heart's rhythm could degenerate into dangerous erratic heart beats, resulting ultimately in sudden cardiac death."

In a statement, Michael J. Ackerman, a Mayo Clinic genetic cardiologist, said: "Correctly identifying which patients are most susceptible to this unwanted, tragic side effect and knowing how to safely use these medications is important in neutralizing this threat."

Like the CHU in Nice, the Mayo Clinic cardiologists say there should be guidance on monitoring a person's QTc through ECGs in order to identify patients at increased risk of the potential COVID-19 treatment.

"Right now, it is the Wild West out there, ranging from doing no QTc surveillance whatsoever and just accepting this potential tragic side effect as part of 'friendly fire,' to having ECG technicians going into the room of a patient with COVID-19 daily, exposing them to coronavirus and consuming personal protective equipment," Ackerman said.

Ferrari said that hydroxychloroquine on its own presents only a small cardiac risk. However, when given alongside the antibiotic azithromycin, with which it is being prescribed in combination for the treatment of coronavirus, the risk increases. He said that for some patients being treated with these drugs, "the remedy is more harmful than the disease itself."

In an interview with NBC, Ackerman said he was concerned about how little attention this potential side effect of hydroxychloroquine was being given, even among health professionals.

"What disturbed me the most was when I was seeing not political officials say these medications are safe but seeing on the news cardiologists and infectious disease specialists say [hydroxychloroquine] is completely safe without even mentioning this rare side effect. That's inexcusable," Ackerman said.

Jinoos Yazdany, Chief of Rheumatology at the Zuckerberg San Francisco General Hospital, told Newsweek that hydroxychloroquine has a "good safety profile" when used in low doses in outpatient settings. "However, we know less about the use of higher doses in critically ill patients," he said. "Moreover, the drug has known cardiac toxicity, including prolongation of the QT interval. This can be especially dangerous in patients taking other medications with similar side effects."

He continued: "It is important for people to remember that this is an entirely experimental therapy for COVID-19. There is insufficient evidence to know whether it has any benefit at all. We need well done, randomized controlled trials to guide use and also to quantify side effects. Patients should also realize that there are a range of experimental therapies being tried for COVID-19, including novel treatments that are being investigated in clinical trials."

The French trial and the side effect seen follows similar experiences in Sweden. Magnus Gisslén at Sahlgrenska University Hospital, told the Gothenburg Post they had stopped the treatment for COVID-19 patients following reports of problems at other hospitals.

"There were reports of suspected more serious side effects than we first thought," he is quoted as saying. "We cannot rule out serious side effects, especially from the heart, and it is a hard-dosed drug. The fact that some seriously ill COVID-19 patients have acute heart problems has raised concerns that chloroquine may be harmful to some patients."

The graphic below, provided by Statista, illustrates the spread of COVID-19 around the globe.

This article has been updated to include quotes from Jinoos Yazdany.

A map showing confirmed COVID-19 cases around the world.
A map showing confirmed COVID-19 cases around the world. Statista

Centers for Disease Control and Prevention Advice on Using Face Coverings to Slow Spread of COVID-19

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