Rheumatic Disease Patients Bear the Brunt of Antimalarial Shortages

November 10, 2020
Laird Harrison

Lessons learned from antimalarial drug shortages during the COVID-19 pandemic: rheumatic disease patients in African and South-East Asia had difficulty obtaining antimalarials as compared to counterparts in the Americas and Europe. Shortages led to worse mental and physical health outcomes. Antimalarials did not protect patients from COVID-19.

When hydroxychloroquine and chloroquine were touted as treatments COVID-19, patients had trouble getting them to treat rheumatic diseases, researchers say.

The shortage resulted in worse health for these patients, particularly in Africa and Southeast Asia, said Emily Sirotich, a doctoral candidate McMaster Centre for Transfusion Research in Hamilton, Ontario. and lead of patient engagement the COVID-19 Global Rheumatology Alliance. At the same time, the drugs did not appear to protect patients from COVID-19.

“The unintended harmful consequences of repurposing antimalarials without adequate evidence highlights the importance of maintaining scientific rigor, even in the context of the pandemic,” she said. Ms. Sirotich presented the finding Saturday at the American College of Rheumatology annual meeting.

Many patients with systemic lupus erythematosus, rheumatoid arthritis (RA) and other rheumatic diseases treat them with hydroxychloroquine or chloroquine.

In the early weeks of the COVID-19 pandemic, speculation about the benefits of these drugs as treatments for COVID-19 got widespread attention, despite the lack of data to support this use.

Sirotich and her colleagues wanted to see whether this caused significant shortages of the drugs. So they analyzed data from the COVID-19 Global Rheumatology Alliance Patient Experience Survey, which was distributed through through patient support organizations and social media and completed by patients and patients’ parents.

Of the 9,393 responses, 3,872 reported the use of antimalarial drugs and 230 said the patient had to stop taking them because their pharmacies had run out.

Among patients with systemic lupus erythematosus, 76.4% were taking antimalarials. The percentage for patients with rheumatoid arthritis was 34.3, and for patients with Sjorgren’s syndrome it was 20.2.

The shortages particularly affected people in Africa, where 26.7% of respondents reported shortages, and in Southeast Asia, where 21.4% reported shortages. In the Americas, 6.8% reported shortages and in Europe 2.1% reported shortages.

“Regional disparities of access should be addressed to ensure all people, particularly those living in developing countries, receive fair and equitable access to these essential medications,” Ms. Sirotich said.

Patients who could not obtain the drugs reported higher rheumatic disease activity and worse mental and physical health compared to those who could. These were statistically significant (P < 0.001).

The COVID-19 infection rate for the respondents who did obtain the antimalarials was 6.7% versus 4.7% for those who did not obtain them. And 13.1% of those with COVID-19 reported that they had used the antimalarials to treat the viral infection. The hospitalization rate among those with COVID-19 who were taking antimalarials was 10.8%.

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REFERENCE

ABSTRACT: 0007. “Antimalarial Drug Shortages During the COVID-19 Pandemic: Results from the Global Rheumatology Alliance Patient Experience Survey.” The annual meeting of the American College of Rheumatology. 9:00 AM, Friday, Nov. 6, 2020

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