The ongoing uncertainty over whether hydroxychloroquine can successfully treat Covid-19 appears to have eroded demand considerably among hospitals, according to new data. At the same time, anecdotal evidence suggests that patients with lupus, a condition for which the drug is approved to treat, are having an easier time filling prescriptions for the first time in weeks.
From the week ending April 17 to the week ending April 24, demand plunged 62% among hospitals placing orders for the decades-old malaria drug. The number of tablets sought fell to 198,500 from 462,850 during that stretch, according to Vizient, a group purchasing organization that negotiates contracts for medicines on behalf of about 3,000 hospitals and health care facilities in the U.S.
At the same time, supplies appear to be stabilizing, most likely due to donations from several large manufacturers — including Bayer, Teva Pharmaceutical and Novartis — that agreed to provide millions of tablets to the U.S. Strategic National Stockpile after the Food and Drug Administration issued an emergency use authorization for hospitals.
As a result, the so-called fill rate — the rate that orders were able to filled and shipped to hospitals — is starting to bounce back. Although the rate hovered around 55% mid-month and then fell to 32% several days later, it now stands at 45%, according to Dan Kistner, group senior vice president for pharmacy solutions at Vizient. He also expects the fill rates to stabilize and improve over time.
The shift comes amid controversy over the extent to which hydroxychloroquine can help Covid-19 patients. The drug, which is approved to treat lupus and rheumatoid arthritis, as well as malaria, had been widely touted a few weeks ago by President Trump, helping to spark a binge of prescription writing and hospital orders that created severe shortages.
The rush occurred even as evidence was lacking that hydroxychloroquine — and a related drug called chloroquine — might be effective in thwarting the novel coronavirus. The picture was further muddied by a growing number of small studies – especially from France and China – that offered tantalizing suggestions of efficacy, but widely criticized for being poorly designed.
Consequently, a growing number of physicians and public health experts cautioned that the tablet should not be embraced as a salve until more data is obtained from several trials under way. Toward that end, the FDA last week issued a cautionary note to health care providers because the drug may cause irregular heart rhythms, especially when used in combination with the azithromycin antibiotic.
Nonetheless, shortages persisted due to supply constraints faced by the companies – mostly in China and India – that supply the active pharmaceutical ingredient for the drug. The problem spread to compound pharmacies as well, after one U.S. supplier boosted wholesale prices for the ingredient after it became harder to obtain raw materials from its own overseas sources.
Meanwhile, lupus and rheumatoid arthritis patients have become collateral damage. For weeks, many were unable to obtain their usual prescriptions, causing concerns about their health. Some also were alarmed after hearing a drumbeat of warnings about side effects risks, according to Kenneth Farber, president of Lupus Research Alliance, an advocacy group that is sponsoring an observational study to assess the incidence of Covid-19 among lupus patients who are already taking hydroxychloroquine for their condition.
Over the past several days, however, he indicated that the shortage has abated most everywhere and lupus patients say they are finding it easier to obtain hydroxychloroquine. He attributed the change to increased production and reservations among some physicians to increasingly prescribe the tablet for Covid-19. But he worries hoarding may return if studies indicate the drug is useful for the coronavirus.
“One very unfortunate aspect of the whole hydroxychloroquine debate is all of the exaggeration promulgated both by the original proponents of its use for Covid-19 and by detractors of the idea of using it. Proponents exaggerated the value of the anecdotal evidence suggesting that hydroxychloroquine was a useful treatment for Covid-19 and detractors, to discourage the use of the drug, exaggerated the side-effects of hydroxychloroquine,” he wrote us.
“This unfortunate controversy had its nature in politics as much as in science. Lupus patients were the victims of the ridiculous controversy.”