Study links proposed HCQ and azithromycin drug combo for COVID-19 to higher risk of heart disease
Since inflammation and pneumonia are two of the features of SARS-CoV-2 infection, some experts have been suggesting the use of HCQ and azithromycin to treat COVID-19.
A combination of hydroxychloroquine (HCQ) and azithromycin is reportedly being used to treat COVID-19 patients. However, if you’ve been keeping up with the news cycle this year, you’ll know that there has been a lot of controversy on HCQ alone and the use and benefits (if any) of the combination.
Now, a multinational, retrospective study, done by a group of researchers at the Columbia University Irving Medical Center, states that the hydroxychloroquine (HCQ) and azithromycin combination can have severe consequences on heart health.
The study, now published in the peer-reviewed journal Lancet Rheumatology, started receiving attention a few months back when it was released in its preprint state. Findings of this study have been used twice (in April and July) by the European Medicine Agency (EMA) to warn against the risks and side effects of HCQ and chloroquine.
The two drugs
Azithromycin is an antibiotic that is used to treat bacterial infections including pneumonia and bronchitis. The drug stops the growth of bacteria and comes in the form of both tablets and liquid.
Hydroxychloroquine belongs to a class of drugs called disease-modifying anti-arthritic drugs or DMARDs. While it is known for the treatment of malaria, HCQ is also used to treat rheumatoid arthritis and systemic lupus erythematosus. The drug modifies the immune system to reduce inflammation.
Since inflammation and pneumonia are two of the features of SARS-CoV-2 infection, some experts have been suggesting the use of HCQ and azithromycin to treat COVID-19 .
Over the past eight months, there have been various studies that indicate the benefits and potential side effects of HCQ and chloroquine alone and in combination with azithromycin.
But scientists are still to come at a conclusion on the effectiveness of these drugs.
The latest study is led by Observational Health Data Sciences and Informatics (OHDSI), an international collaboration of healthcare workers, academics, industry scientists and regulators, which collects and provides information and data on the history of a disease, the healthcare delivery and effects of interventions used to treat a condition so that reliable healthcare decisions can be made.
To collect the data, the researchers studied various groups of patients (18 years or older), with rheumatoid arthritis or other conditions, that were taking HCQ with azithromycin, HCQ with amoxicillin and HCQ with sulfasalazine. While amoxicillin is an antibiotic, sulfasalazine is also a DMARD like HCQ.
About 9,56,374 HCQ users, 3,10,350 sulfasalazine users, 3,23,122 users of HCQ and azithromycin and 3,51,956 users of HCQ with amoxicillin were included in the study. The study included data from electronic health records and administrative claims spanning over 20 years. The patients were from six different countries including Spain, Japan, Germany, the UK, the US and the Netherlands.
The study found that HCQ does not lead to any adverse effects when used in the short term -- up to 30 days. However, in the long-term, patients using HCQ had a 65 percent increased risk of death from cardiovascular conditions than those who used sulfasalazine.
The risk was even greater for those who took a combination of HCQ and azithromycin, even in the short term. The combination also increased (about 15-20 percent) the incidence of chest pain and heart failure.
Dr Daniel Prieto-Alhambra, the co-senior author of the study, said in a news release, “Hydroxychloroquine, both alone and in combination with azithromycin, gained strong consideration as a potential COVID treatment without a large-scale study of its overall safety profile... We had access to an unprecedented amount of data on this drug, and we were relieved to find no worrying side effects in the short-term use of hydroxychloroquine. However, when prescribed in combination with azithromycin, it may induce heart failure and cardiovascular mortality and we would urge caution in using the two together."
For more information, read our article on Is hydroxychloroquine really effective against COVID-19 ?
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