COVID-19 antimalarial shortages affected rheumatology patients’ physical, mental health
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Antimalarial drug shortages due to COVID-19 affected more rheumatology patients in African and East Asian regions than those in the Americas and Europe, noted data from the COVID-19 Global Rheumatology Alliance Patient Experience Survey.
Results of the survey, which launched in April, showed that patients who experienced shortages also reported poorer physical and mental health.
“With the sudden onset of the COVID-19 pandemic, the global research and medical community came together to explore the impacts of the COVID-19 pandemic and identify potential treatments for SARS-CoV-2 infection, Emily Sirotich, a doctoral student at McMaster Centre for Transfusion Research in Hamilton, Ontario, and patient engagement lead of the COVID-19 Global Rheumatology Alliance, told Healio Rheumatology.
“Antimalarials, such as hydroxychloroquine and chloroquine, were considered potential treatments for the virus and various clinical trials around the world sought to explore their effectiveness in the treatment of SARS-CoV-2 infection,” she added. “Since hydroxychloroquine is an essential treatment for RA and lupus, reported drug shortages of antimalarials became a major concern.”
In the early days of the pandemic, the purported benefit of hydroxychloroquine and chloroquine to combat SARS-CoV-2 led to worldwide shortages for patients and providers in the rheumatology community. The COVID-19 Global Rheumatology Alliance, a grassroots organization comprised of academic and community rheumatologists, scientists, researchers and patient partners, formed quickly and created the Patient Experience Survey to examine available evidence on the efficacy of these antimalarials on COVID-19 and the effects of the shortages on patients in the community.
Sirotich and colleagues distributed the survey online via social media and patient support organizations. Respondents (n = 9,393) included patients with rheumatic disease or parents of pediatric rheumatology patients who anonymously provided information on their diagnosis, any medications, COVID-19 status and disease outcomes. The researchers then examined the effects of the shortage on patients’ physical and mental health by comparing mean values with two-sided independent t-tests to identify significant differences, according to Sirotich.
Nearly half of respondents (41.2%) were taking antimalarials, with 6.2% of these unable to continue their dosing due to pharmacy shortages, according to the results. More patients in African regions (26.7%) and Southeast Asia (21.4%) reported shortages at their pharmacies compared with those in the Americas (6.8%) and Europe (2.1%), Sirotich said.
Levels of rheumatic disease activity were reportedly higher among patients who experienced medication shortages vs. those who did not (P < .001). Additionally, those affected by shortages reported poorer mental and physical health (P < .001 for both).
COVID-19 infection was reported in 519 patients, of whom 68 (13.1%) indicated that an antimalarial was prescribed to treat their infection. Infection rates were similar among patients taking antimalarials vs. those who were not (6.7% vs. 4.7%), and 10.8% of patients with COVID-19 who were taking antimalarials reported hospitalization.
“This study highlights the importance of maintaining scientific rigor even in the context of a pandemic to prevent the harmful consequences of repurposing of medications without adequate evidence for benefit,” Sirotich said. “Patients who rely on access to their hydroxychloroquine or chloroquine prescriptions for their rheumatic diseases were impacted by the support of the use of hydroxychloroquine in the treatment of COVID-19 infection. The regional disparities noted in our study also highlights the need to ensure global access to essential medications in a fair and equitable manner.”
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Sirotich E. Abstract #0007. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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