A call to caution when hydroxychloroquine is given to elderly patients with COVID-19

• Main Authors: Julian J. Gabor, Andrea Kreidenweiss, Stefan Weber, Moaaz Salama, Mihaly Sulyok, Zita Sulyok, Erik Koehne, Meral Esen, Benno Kreuels, Parichehr Shamsrizi, Erwin Biecker, Benjamin Mordmüller, Christoph P. Berg, Stefano Fusco, Carsten Köhler, Stefan Kubicka, Jens Leitlein, Marylyn Addo, Michael Ramharter, Matthias Schwab, Alfred Lennart Bissinger, Thirumalaisamy P. Velavan, Sanjeev Krishna, Peter G. Kremsner
• Format: Article
• Language: English
• Published: Elsevier 2021-05-01
• Series: International Journal of Infectious Diseases
• Subjects: COVID-19; Hydroxychloroquine; Contraindications; Adverse effects; SARS-CoV-2
• Online Access: http://www.sciencedirect.com/science/article/pii/S1201971221003209

Introduction: Use of hydroxychloroquine in patients with coronavirus disease 2019 (COVID-19) was widespread and uncontrolled until recently. Patients vulnerable to severe COVID-19 are at risk of hydroxychloroquine interactions with co-morbidities and co-medications contributing to detrimental, including fatal, adverse treatment effects. Methods: A retrospective survey was undertaken of health conditions and co-medications of patients with COVID-19 who were pre-screened for enrolment in a randomized, double-blind, placebo-controlled hydroxychloroquine multi-centre trial. Results: The survey involved 305 patients [median age 71 (interquartile range 59–81) years]. The majority of patients (n = 279, 92%) considered for inclusion in the clinical trial were not eligible, mainly due to safety concerns caused by health conditions or co-medications. The most common were QT-prolonging drugs (n = 188, 62%) and haematologic/haemato-oncologic diseases (n = 39, 13%) which prohibited the administration of hydroxychloroquine. In addition, 165 (54%) patients had health conditions and 167 (55%) patients were on co-medications that did not prohibit the use of hydroxychloroquine but had a risk of adverse interactions with hydroxychloroquine. The most common were diabetes (n = 86, 28%), renal insufficiency (n = 69, 23%) and heart failure (n = 58, 19%). Conclusion: The majority of hospitalized patients with COVID-19 had health conditions or took co-medications precluding safe treatment with hydroxychloroquine. Therefore, hydroxychloroquine should be administered with extreme caution in elderly patients with COVID-19, and only in clinical trials.