Insufficient antimalarial supply for rheumatic disease treatment in the early COVID-19 pandemic

According to the results of a survey, the use of antimalarial drugs for COVID-19 patients during the early pandemic led to a shortage of hydroxychloroquine and chloroquine as long-term treatment for patients with rheumatic diseases.

“Early in the COVID-19 pandemic, hydroxychloroquine and chloroquine were promoted for treatment and prevention of SARS-CoV-2 infection, despite little evidence for their efficacy,” said Ms Emily Sirotich (COVID‐19 Global Rheumatology Alliance Steering Committee and McMaster University, Canada) [1]. Based on data from the COVID‐19 Global Rheumatology Alliance Patient Experience survey, the prevalence and impact of antimalarial drug shortages were assessed. Furthermore, the potential link between the use of antimalarial drugs and a decreased risk of a SARS-CoV-2 infection in rheumatoid arthritis patients was studied.

Anonymously, 9,393 patients entered data about the type of their rheumatic disease diagnosis, medication, COVID-19 status, and disease activity, as well as information about physical and mental health via the Patient-Reported Outcomes Measurement and Information System (PROMIS).

The participants had a mean age of 46.1 years, 90% were female, 41.2% used medication containing antimalarials, and the most common diagnoses were systemic lupus erythematosus (38.9%) and rheumatoid arthritis (38.6%). A positive COVID-19 status was reported by 5.5% (n=519) overall; 6.7% in the group using antimalarials and 4.7% in those only using other drugs. Of the COVID-19-positive study subjects treated with antimalarials, 10.8% were hospitalised and 13.1% received antimalarials as COVID-19 treatment.

“In summary, 6.2% of patients taking antimalarials were unable to continue taking their medication, due to a lack of supply of their pharmacy,” Ms Sirotich summarised. In contrast to patients not on antimalarials, these patients had significantly higher activity of their rheumatic disease, worse physical, and poorer mental health (P<0.001 for all comparisons). Moreover, taking antimalarials for rheumatic disease did not protect the participants from COVID-19 as such, or hospitalisation for COVID-19.

“The unintended harmful consequences of repurposing antimalarials, without adequate evidence for benefit, highlights the importance of maintaining scientific rigour even in the context of a pandemic,” Ms Sirotich stressed.

1. Sirotich E, et al. Antimalarial drug shortages during the COVID-19 pandemic: results from the Global Rheumatology Alliance Patient Experience survey. P0007, ACR Convergence 2020, 5-9 Nov.

Posted on 18 January 20218 April 2024