Patients With SLE Experienced Delayed Access to Hydroxychloroquine During COVID-19 Pandemic

After hydroxychloroquine (HCQ) was identified as a potential therapy for coronavirus disease 2019 (COVID-19), more than 100 trials were registered to test the drug to treat the respiratory disease. Although the efficacy of HCQ to treat COVID-19 remains to be seen, the increased demand for the therapy has reduced access to it for patients with systemic lupus erythematosus (SLE), and these access issues occurred in multiple countries.

The diminished supplies of HCQ for patients with SLE can result in SLE flare (a measurable increase in disease activity) after HCQ withdrawal, noted the authors of a letter published in Annals of Rheumatic Diseases.¹

A group of researchers from around the world had distributed an electronic survey to understand physician experience with HCQ shortages during the pandemic. Responses came from 13 countries, and 55% had reported that they were either currently (16%) or had previously (39%) experienced HCQ shortages among patients with SLE during the COVID-19 pandemic.

A median of 40 (interquartile range [IQR], 15-90) patients per physician were affected by HCQ shortages, according to the 17 respondents who provided estimates. In addition, according to 7 of the respondents, shortages of HCQ typically resolved within 2 to 8 weeks. Respondents from Sweden, Denmark, Singapore, and South Korea reported their patients with SLE had no HCQ access issues.

The majority (74%) reported system-level measures that were taken to preserve HCQ access for patients with SLE during the pandemic. These measures include:

• Limiting prescribing capabilities to specific diagnoses (n = 10)
• Limiting prescribing capabilities to specific specialties (n = 9)
• Limiting dispensed supplies (n = 3)

However, there were some downsides to those measures.

“Some restrictions may have inadvertently delayed HCQ access for patients with SLE, who had to wait for physicians to update diagnostic codes in medical records, confirm diagnoses with pharmacies, or apply for waivers,” the researchers noted.

Annals of Rheumatic Diseases published a letter in response from German researchers who conducted their own survey to understand the situation among patients with SLE in Germany.² They received 554 responses, but 185 were excluded based on prespecified answers or incomplete data.

Nearly all (95.8%) said they considered HCQ essential for their SLE treatment, and 70.0% were concerned they might not be able to receive their prescription. As a result, 8.8% of respondents reduced their daily dose in case of supple issues. Less than half (44.4%) said they had not experienced any supply issues, but nearly the same amount (45.0%) said they had experienced supply issues. Almost 10% had stockpiled HCQ.

“Patients with SLE and caregivers are facing challenges with the improper use of essential drugs, and healthcare policies need to take this into account,” the authors wrote.

References

1. Mendel A, Bernatsky S, Askanase A, et al. Hydroxychloroquine shortages among patients with systemic lupus erythematosus during the COVID-19 pandemic: experience of the Systemic Lupus International Collaborating Clinics. Ann Rheum Dis. Published online June 25,2020. doi:10.1136/annrheumdis-2020-218164

2. Plüß M, Chehab G, Korsten P. Concerns and needs of patients with systemic lupus erythematosus regarding hydroxychloroquine supplies during the COVID-19 pandemic: results from a patient-centred survey. Ann Rheum Dis. Published online July 2, 2020. doi:10.1136/annrheumdis-2020-217967