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Nick Mercuro

Beth Israel Deaconess Medical Center

Nick MercuroIn the early days of the pandemic, clinicians were eager to find existing therapies that could be repurposed for the treatment of COVID-19. While the practice of medicine is built upon evidence gleaned from clinical trials, this was missing in the context of COVID-19. The evidence used to promote potential therapies was based on non-peer reviewed, often times pre-printed, case series lacking a control arm. On the grand scheme of clinical evidence, this was barely above that of anecdotal evidence.

Hydroxychloroquine was thrust into the spotlight, based on some news reports and promotion by public figures. It was incorporated into many institution’s COVID-19 treatment algorithms, including ours. In an effort to centralize and standardize the treatment of patients with COVID-19, any medication with potential activity was put on restriction, and required approval by the infectious diseases clinicians or antimicrobial stewardship.

While most patients received the medication in the context of clinical trials, the antimicrobial stewardship team was able to have a 10,000 foot view of all the patients. It was through this unique perspective that Nick Mercuro, PharmD, BCIDP, a clinical pharmacy specialist and infectious diseases pharmacist, was able to identify a cluster of adverse reactions and wondered if there were larger implications.

In April 2020, Dr. Mercuro led a team of pharmacists, infectious diseases physicians, and cardiologists in a review of 90 patients who received hydroxychloroquine at our institution for the treatment of COVID-19. Instead of focusing on the efficacy of the medication, they focused on the safety. Special attention was given to the cardiovascular effects and QTc prolongation. Their findings were significant.

Eighteen patients experienced a prolonged QTc of 500 msec or more, with 10 patients experiencing a change of more than 60 msec from baseline. Ten patients had hydroxychloroquine discontinued because of these effects. These risks were often greater in patients receiving concomitant azithromycin. This study included the first reported COVID-19 patient to develop torsades de pointes while on concomitant hydroxychloroquine and azithromycin. These results were published in JAMA Cardiology on May 1. This was before the hydroxychloroquine randomized controlled trials were completed or terminated early due to lack of efficacy. By publishing these results in a peer-reviewed journal, Dr. Mercuro and his colleagues alerted clinicians to the potential dangers of this therapy, and encouraged careful patient selection.

Nick Mercuro, PharmD, BCIDP, is a clinical pharmacy specialist, infectious diseases, at Beth Israel Deaconess Medical Center.


Posted April 1, 2021