Amiodarone for the Treatment of Arrhythmias in COVID-19 Patients Does Not Increase the Risk of Pulmonary Fibrosis: A Retrospective Cohort Study
Dae David B Money, Dae Hyun Lee, Ari Hadar, Justin Doherty, Christopher Malanga, Alexa Serino, Adam J Cohen
Cureus, doi:10.7759/cureus.34109
Amiodarone is a class III antiarrhythmic medication used to treat atrial and ventricular tachyarrhythmias. Pulmonary fibrosis from amiodarone use is a well-documented side effect. Pre-COVID-19 pandemic studies have shown that amiodarone-induced pulmonary fibrosis occurs in 1%-5% of patients and usually occurs between 12 to 60 months after initiation. The risk factors associated with amiodarone-induced pulmonary fibrosis include a high total cumulative dose (treatment longer than two months) and high maintenance dose (>400 mg/day). COVID-19 infection is also a known risk factor for developing pulmonary fibrosis and occurs in approximately 2%-6% of patients after a moderate illness. This study aims to assess the incidence of amiodarone in COVID-19 pulmonary fibrosis (ACPF). This is a retrospective cohort study with 420 patients with COVID-19 diagnoses between March 2020 and March 2022, comparing two populations, COVID-19 patients with exposure to amiodarone (N=210) and COVID-19 patients without amiodarone exposure (N=210). In our study, pulmonary fibrosis occurred in 12.9% of patients in the amiodarone exposure group compared to 10.5% of patients in the COVID-19 control group (p=0.543). In multivariate logistic analysis, which controlled for clinical covariates, amiodarone use in COVID-19 patients did not increase the odds of developing pulmonary fibrosis (odds ratio (OR): 1.02, 95% confidence interval (CI): 0.52-2.00). The clinical factors associated with the development of pulmonary fibrosis in both groups included a history of preexisting interstitial lung disease (ILD) (p=0.001), exposure to prior radiation therapy (p=0.021), and higher severity of COVID-19 illness (p<0.001). In conclusion, our study found no evidence that amiodarone use in COVID-19 patients increased the odds of developing pulmonary fibrosis at six-month follow-up. However, long-term amiodarone usage in the COVID-19 population should be based on the physician's discretion.
Additional Information Disclosures Human subjects: Consent was obtained or waived by all participants in this study. The University of South Florida Institutional Review Board (IRB) Department issued approval STUDY003720. The IRB determined that this protocol meets the criteria for exemption from IRB review. In conducting this protocol, you are required to follow the requirements listed in the INVESTIGATOR MANUAL (HRP-103). Your study qualifies for a waiver of the requirement for signed authorization as outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule regulations at 45 CFR 164.512(i). A waiver of HIPAA authorization is granted for this retrospective chart review of patients who presented to Tampa General Hospital (TGH) or University of South Florida (USF) Outpatient Clinics and were diagnosed with COVID-19 within the date range in the protocol. This waiver allows the study team and/or its honest broker to obtain Protected Health Information (PHI) of the patients in this cohort from the TGH medical record (Epic) and the USF medical record (Epic) (ICD-10 codes: U07.1, T46.2X5). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial..
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doi:10.1056/NEJMoa021328DOI record:
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