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.

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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.

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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.”

  • I think they have been using that medication in India they gave it to patients with early symptoms it seems to be working they have a lot lower death rate than the usa and theirs like 5 times as many people I think people want this to continue longer to make trump look bad

  • There are many examples of early use of the HCQ + azithro + zinc protocol with excellent results from all over the world. The EUA is for late, last resort use in the sickest patients and without the adjunct meds which are critical. The only studies that get any attention are late use, hospitalized patients – too late for it to do any good, especially without the zinc. There is also a recent study from Italy that documents the positive prophylactic effects in lupus patients already on the medication.

    It is criminal how this covid-19 life-saving drug has been vilified for political purposes. I hope medical professionals will look beyond the negative press, read all of the research and start prescribing this protocol for most covid-19 patients. Trials are getting underway in NYC.

    Concerning the cardiac effects, in 2016, the CDC concluded anti-malarials, specifically HCQ, had a low risk of negative cardiac effects. This side effect has been labeled rare.

  • “But if so, why did it work? And will it work in others? To what extent? We still need answers to these and other questions.”
    It’s certainly not Big Pharma who will give you the answers. To get the answers to your questions, you need to at least pretend to look for them : there are tons of information out there….

    Why did it work? Because the association of HCQ + azithro has been showing that it stop the viral load in patients within 6 and 10 days.
    That’s why it drastically reduces the needs for heavy hospitalizations.
    Will it work in others ?
    Many thousands have been treated with this association in the last 7 weeks, all over the world, and the studies show that the countries which used it at the beginning of the pandemics have the lowest death rates of all.
    To what extent ?
    To complete cure, without having to be hospitalized, for a vast majority of them, because it stops the virus from doing its effects on the lungs, the heart and the blood (and probably the brain).

    • PS : that’s why I find particularly amusing that Dr. Fauci, who’s trying to promote Gilead’s Remdesivir in spite of the bad results in the existing studies, affirms without a laugh : “It is a very important proof of concept because what it is proving is that a drug can block this virus”
      As if HCQ + azithro has not been doing this for nearly 2 months…
      “The mortality rate trended towards being better in the sense of less deaths in the remdesivir group – 8 percent versus 11 percent in the placebo group.”
      Ah, ah, “trended towards being better”, no less…
      While Dr. Raoult can boast with 15 deaths for 3181 patients treated (and most of these were elderly patients at the early start of the trials — 10 deaths out of 1100 people, and 5 in the remaining 2000 treated patients….
      But I bet that’s not enough proof, is it ?
      Oh, by the way, how much will cost a Remdesivir treatment ?

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