Investigating the effects of remdesivir on corrected QT interval in patients with severe COVID-19 disease: A historical cohort study

Purpose: There is little information about the risk of drug-induced QT prolongation by remdesivir as the most important FDA approved anti COVID-19 drug. Long corrected QT interval (QTc) is a marker of an adverse prognosis which may lead to torsade de pointes and degenerate into ventricular fibrillation. The aim of this study was to determine the effects of remdesivir on QTc in patients with severe COVID 19 disease. Methods: : This study was a historical cohort study on 249 patients with severe COVID-19 disease who were considered for intravenous remdesivir therapy. Electrocardiograms were obtained at the baseline and fifth days of remdesivir therapy to determine whether there is any significant change in QTc and QT interval following therapy. Blood samples were also taken at the time of admission and then daily to measure complete blood count and the plasma levels of potassium, sodium, fasting blood glucose (FBS), and creatinine (Cr). Results: : The results of this analysis showed blood pressure and heart rate (HR) were lower and total white blood cells and neutrophil counts, FBS and Cr levels were higher at fifth day than first day of study (P value<0.001). Furthermore, QT interval was more prolonged at fifth day compared with beginning of remdesivir therapy (379.51± 34.90ms vs. 366.72± 30.97ms, P value<0.001). However, QTc was not significantly increased at fifth day in comparison with first day (402.37±33.62ms vs. 400.76±30.18ms, P value=0.524). Univariate logistic regression analysis showed increased heart rate was associated with a significant decrease in QT interval (B= 0.955, 95% CI: 0.933- 0.977, P value< 0.001) (Table 4). Conclusions: : The result of our study showed remdesivir at usual therapeutic dose did not have any significant effect on QTc prolongation. However, there was significant QT prolongation following remdesivir therapy due to effect of HR on QT interval. It was due to the fact that remdesivir exerted a rate lowering effect with resultant increase in QT interval.