Possible Consequences of a Shortage of Hydroxychloroquine for Patients with Systemic Lupus Erythematosus amid the COVID-19 Pandemic

Peschken, Christine A.

doi:10.3899/jrheum.200395

Cited by 36 publications

(40 citation statements)

References 36 publications

(32 reference statements)

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“…Recent reports have indicated the shortage of chloroquine (CQ) and hydroxychloroquine (HCQ) which would create problems for the patients with systematic lupus erythematosus and rheumatological and dermatological disorders (80). The probable causes of shortage are stocking of drugs by patients, hospital administration, drug retailers, and physicians (81). Drug regulatory pharmacists must observe any unusual sale of a particular medicine or equipment in order to make strict oversight against parties involved in price gouging and those taking advantage of the heightened demand for supplies.…”

Section: Ensuring Good Selling Practices (Gsps)mentioning

confidence: 99%

Multilevel Engagements of Pharmacists During the COVID-19 Pandemic: The Way Forward

Mallhi

Liaqat

Abid³

et al. 2020

Front. Public Health

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Severe acute respiratory syndrome caused by the novel coronavirus (SARS-CoV-2) was first reported in China in December 2019 which was later declared to be a public health emergency of international concern by the World Health Organization (WHO). This virus proved to be very contagious resulting in life-threatening respiratory intricacies posing overall public health and governance challenges. Amid the coronavirus pandemic and the unprecedented increase in healthcare demands, only inventive and adaptive practice among healthcare professionals is the need of the hour. Pharmacy services are an important mainstay in the public health and have considerable potential to combat the coronavirus disease 2019 (COVID-19) pandemic. Pharmacists working in several localities and health facilities are linked to patients either directly or indirectly. They can act swiftly in public health response such as drafting professional service guidance to pharmacists working in various healthcare facilities, ensuring effective medicine supply system, monitoring and resolving drug shortage issues, establishing and promoting remote pharmacy services, counseling the public on infection prevention basics, educating about proper use of personal protective equipment, discouraging self-medication, participating in clinical trials, small-scale manufacturing of sanitizers and disinfectants, busting the prevailing myths, and conducting drug evaluation and active surveillance. These interventions will help ease unprecedented burden on healthcare facilities during the ongoing pandemic and eventually will add value to patients and the healthcare system. The current manuscript accentuates the potential roles and activities that pharmacists can initiate in various healthcare facilities to help in relieving pressure on the overwhelmed healthcare system. The information and suggestions offered in this review could help in the restructuring of existing pharmacy services by governments, public health bodies, and policy makers in response to the COVID-19 pandemic. Moreover, this manuscript will underscore any unrealized potential among pharmacists working in various sectors including community, hospital, industry, and drug regulatory authorities.

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Section: Ensuring Good Selling Practices (Gsps)mentioning

confidence: 99%

Multilevel Engagements of Pharmacists During the COVID-19 Pandemic: The Way Forward

Mallhi

Liaqat

Abid³

et al. 2020

Front. Public Health

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“…Practitioners were under considerable pressure from patients and from the community to embrace off-label use of agents viewed as potentially beneficial. Furthermore, we estimated (using current drug par levels, projections, and external reports [ 7 – 9 ]) that drug supplies were already or would soon be depleted by off-label use. We sought to offer patients treatment as quickly as possible in a way that would prevent overuse of untested medications with possible adverse effects while protecting the drug supply for patients who depend on those drugs for their indicated conditions.…”

mentioning

confidence: 99%

Hydroxychloroquine versus Azithromycin for Hospitalized Patients with Suspected or Confirmed COVID-19 (HAHPS). Protocol for a Pragmatic, Open-Label, Active Comparator Trial

et al. 2020

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Coronavirus disease (COVID-19) is a potentially fatal illness with no proven therapy beyond excellent supportive care. Treatments are urgently sought. Adaptations to traditional trial logistics and design to allow rapid implementation, evaluation of trials within a global trials context, flexible interim monitoring, and access outside traditional research hospitals (even in settings where formal placebos are unavailable) may be helpful. Thoughtful adaptations to traditional trial designs, especially within the global context of related studies, may also foster collaborative relationships among government, community, and the research enterprise. Here, we describe the protocol for a pragmatic, active comparator trial in as many as 300 patients comparing two current “off-label” treatments for COVID-19—hydroxychloroquine and azithromycin—in academic and nonacademic hospitals in Utah. We developed the trial in response to local pressures for widespread, indiscriminate off-label use of these medications. We used a hybrid Bayesian-frequentist design for interim monitoring to allow rapid, contextual assessment of the available evidence. We also developed an inference grid for interpreting the range of possible results from this trial within the context of parallel trials and prepared for a network meta-analysis of the resulting data. This trial was prospectively registered ( ClinicalTrials.gov Identifier: NCT04329832) before enrollment of the first patient. Clinical trial registered with www.clinicaltrials.gov (NCT04329832).

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“…However, the medical community was concerned regarding the potential cardiovascular adverse effects of off-label HCQ use. Despite all the controversies surrounding HCQ, its use prevailed in the earlier part of the pandemic, leading to stockpiling and shortage of HCQ in international markets, then followed by a swift decline in its use [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most debilitating complication of SARS-CoV-2 infection is acute respiratory failure, necessitating the use of IMV and other concurrent resource-intensive tools in critical care units [ 15 ]. Previous studies have reported mixed results, showing 11% to 44% use of IMV in patients receiving HCQ and TCZ [ 13 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Hydroxychloroquine and Tocilizumab in Patients With COVID-19: Single-Center Retrospective Chart Review

Roomi¹,

Ullah²,

Ahmed³

et al. 2020

J Med Internet Res

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Background During the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial. Objective The purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19. We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. Methods A retrospective cohort study was performed to determine the impact of HCQ and TCZ use on hard clinical outcomes during hospitalization. A total of 176 hospitalized patients with a confirmed COVID-19 diagnosis was included. Patients were divided into two comparison groups: (1) HCQ (n=144) vs no-HCQ (n=32) and (2) TCZ (n=32) vs no-TCZ (n=144). The mean age, baseline comorbidities, and other medications used during hospitalization were uniformly distributed among all the groups. Independent t tests and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios with 95% CIs, respectively. Results The unadjusted odds ratio for patients upgraded to a higher level of care (ie, intensive care unit) (OR 2.6, 95% CI 1.19-5.69; P=.003) and reductions in C-reactive protein (CRP) level on day 7 of hospitalization (21% vs 56%, OR 0.21, 95% CI 0.08-0.55; P=.002) were significantly higher in the TCZ group compared to the control group. There was no significant difference in the odds of in-hospital mortality, upgrade to intensive medical care, need for invasive mechanical ventilation, acute kidney failure necessitating dialysis, or discharge from the hospital after recovery in both the HCQ and TCZ groups compared to their respective control groups. Adjusted odds ratios controlled for baseline comorbidities and medications closely followed the unadjusted estimates. Conclusions In this cohort of patients with COVID-19, neither HCQ nor TCZ offered a significant reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. These results are similar to the recently published preliminary results of the HCQ arm of the Recovery trial, which showed no clinical benefit from the use of HCQ in hospitalized patients with COVID-19 (the TCZ arm is ongoing). Double-blinded randomized controlled trials are needed to further evaluate the impact of these drugs in larger patient samples so that data-driven guidelines can be deduced to combat this global pandemic.

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Possible Consequences of a Shortage of Hydroxychloroquine for Patients with Systemic Lupus Erythematosus amid the COVID-19 Pandemic

Cited by 36 publications

References 36 publications

Multilevel Engagements of Pharmacists During the COVID-19 Pandemic: The Way Forward

Multilevel Engagements of Pharmacists During the COVID-19 Pandemic: The Way Forward

Hydroxychloroquine versus Azithromycin for Hospitalized Patients with Suspected or Confirmed COVID-19 (HAHPS). Protocol for a Pragmatic, Open-Label, Active Comparator Trial

Efficacy of Hydroxychloroquine and Tocilizumab in Patients With COVID-19: Single-Center Retrospective Chart Review

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