After preliminary release of a study found that a cheap steroid reduced deaths by a third in hospitalized Covid-19 patients, hospitals across the U.S. saw a surge in demand for the drug, and there is a shortage of several injectable versions.
Specifically, hospital orders for dexamethasone, a commonly used and inexpensive corticosteroid, spiked 183% on June 16, when study researchers released top-line data that suggested the decades-old therapy could possibly improve the odds of survival in the sickest patients. The study was run by scientists at the University of Oxford in the U.K.
From June 16 through June 19, hospital demand jumped 610%. And the so-called fill rate — the rate at which orders were able to be filled and shipped to hospitals — plummeted from 97% to just 54% by June 19, 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 least three manufacturers of the injectable version reported shortages as of Wednesday, according to the American Society of Health-System Pharmacists, which regularly compiles information on drugs that are in short supply among hospitals across the U.S. Two of the three manufacturers — Fresenius Kabi and Hikma — cited increased demand. The third manufacturer, AuroMedics, did not provide a reason for the shortage. There is no indication that a shortage exists for the tablet version, a market largely monopolized by Hikma Pharmaceuticals, according to 46Brooklyn, a research firm that tracks the pharmaceutical supply chain.
The sudden spike is almost predictable, given the intense interest in any treatment that might help Covid-19 patients. A similar jump in demand was seen earlier this year after President Trump touted two old malaria drugs — hydroxychloroquine and chloroquine — for treating the coronavirus, though studies have since found the drugs are not effective treatments for Covid-19. Orders also shot up for medicines used to treat hospitalized Covid-19 patients on ventilators.
“I don’t think it’s a surprise, but we now have such dramatic changes in demand based upon information which is coming very rapidly,” said Steven Lucio, vice president of pharmacy solutions at Vizient. “And we’re seeing it especially with Covid, because everyone is affected by it and it’s a global problem. So it’s another example of how challenging it is for the supply chain to catch up.”
It is worth noting that demand for dexamethasone fell back by nearly half by June 19, which was three days after the initial announcement that the drug appeared to help hospitalized Covid-19 patients, according to the Vizient data. The drug is usually widely available and is used to treat conditions including rheumatoid arthritis, asthma, and some cancers.
Where demand is headed remains to be seen. Earlier this week, the University of Oxford study was posted on medRxiv, a preprint server where a growing number of studies are appearing before being peer-reviewed and published in medical journals. The additional details will give physicians an opportunity to determine the extent to which they will use dexamethasone for Covid-19 patients.
Another unknown is whether ongoing shortages will cause problems for other patients who are given the drug to treat rheumatoid arthritis, for instance. This sort of problem emerged with hydroxychloroquine, which is regularly prescribed to lupus patients, but was widely sought after because there was a belief the drug could prevent, not just treat, Covid-19.
One physician suggested the same scenario is less likely to emerge for several reasons.
“Keep in mind, hydroxychloroquine was absolutely, unequivocally the mainstay for lupus patients,” said Jill Buyon, professor of rheumatology at NYU School of Medicine and director of rheumatology at NYU Langone Health, where she also serves as director of its Lupus Center. “There’s a big difference here. In terms of its use in general rheumatology, we all would do anything to keep our patients off steroids in our general use.”
If patients need a steroid, dexamethasone would be a third choice after prednisone and methylprednisolone, she added. “As everyday rheumatologists, yes, you can get a bang of anti-inflammation, but it’s not like hydroxychloroquine where you’re depending on it on a daily basis. And I think there’s a huge difference.”
Elizabeth Cooney contributed to this report.