Patients reported international hydroxychloroquine shortages due to COVID-19

November 06, 2020

ATLANTA -- A new study shows that patients with rheumatic diseases across Africa, Southeast Asia, the Americas and Europe had trouble filling their prescriptions of antimalarial drugs, including hydroxychloroquine, during the 2020 global coronavirus pandemic, when antimalarials were touted as a possible COVID-19 treatment. Patients who could not access their antimalarial drugs faced worse physical and mental health outcomes as a result. Details of the research was presented at ACR Convergence, the American College of Rheumatology's annual meeting (ABSTRACT #0007).

Systemic lupus erythematosus, also called lupus or SLE, is a chronic (long-term) disease that causes systemic inflammation which can affect multiple organs: the skin, joints, kidneys, the tissue lining the lungs (pleura), heart (pericardium) and brain. Many patients experience fatigue, weight loss and fever. Antimalarial drugs are taken regularly by most people with lupus, as well as many with rheumatoid arthritis (RA) and other rheumatic diseases.

In the early weeks of the global SARS-CoV-2 (COVID-19) pandemic, two antimalarial drugs often used to treat lupus and RA, hydroxychloroquine and chloroquine, were touted to potentially prevent or treat COVID-19 infections. Both drugs were suddenly repurposed as COVID-19 treatments despite a lack of data to support this use, leading to worldwide shortages of both. A team of international researchers launched this study to assess the effects of antimalarials on COVID-19 infection and the impact of drug shortages on people with rheumatic disease.

"The COVID-19 Global Rheumatology Alliance's Patient Experience Survey was launched in April 2020 during the early days of the pandemic, when the scientific and research communities were under extraordinary pressure to identify safe and effective treatments for SARS-CoV-2. Since hydroxychloroquine is an essential treatment for RA and lupus, reported drug shortages of antimalarials became a major concern," says the study's lead author, 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. "The aims of this study were to assess the prevalence and impact of drug shortages during the COVID-19 pandemic, and whether the use of antimalarials in patients with rheumatic disease was associated with a lower risk of COVID-19 infection."

Data for the new study was collected using the COVID-19 Global Rheumatology Alliance Patient Experience Survey. The survey was distributed online through patient support organizations and social media. Both patients with rheumatic diseases and parents of pediatric patients anonymously completed the surveys with information on their rheumatic disease diagnosis, medications they take, COVID-19 status and any disease outcomes. The researchers evaluated the impact of antimalarial drug shortages on patients' disease activity, as well as their mental health and physical health.

Of the 9,393 people who responded to the survey, 3,872 were taking antimalarial drugs and 230 said they were unable to continue taking their medications because of a lack of supply at their pharmacy. Antimalarial shortages were worse for people in Africa and Southeast Asia: 26.7% of respondents in Africa and 21.4% of respondents in Southeast Asia reported inadequate supplies at local pharmacies. Patients in the Americas (6.8%) and Europe (2.1%) also reported being unable to fill their prescriptions at their pharmacy due to lack of supply.

The study found that patients on antimalarials and those who did not take these drugs had similar rates of COVID-19 infection. A total of 28 patients with COVID-19, who were also taking antimalarials, were hospitalized. Of 519 patients diagnosed with COVID-19 in the survey, 68 reported that they were prescribed an antimalarial for their coronavirus infection. Patients who could not fill their antimalarial prescriptions experienced higher levels of disease activity and also experienced worse mental and physical health symptoms, the study found.

"The findings from this study highlight the harmful consequences of repurposing antimalarials, without adequate evidence for benefit, on patients who rely on access to their hydroxychloroquine or chloroquine prescriptions for their rheumatic diseases," says Ms. Sirotich. "It is necessary to maintain scientific rigor even in the context of a pandemic and recognize the potential impacts of drug shortages. It is also important to address regional disparities in access to medications, to ensure all people, particularly those living in developing countries, receive fair and equitable access to their essential medications."
About ACR Convergence

ACR Convergence, the ACR's annual meeting, is where rheumatology meets to collaborate, celebrate, congregate, and learn. Join ACR for an all-encompassing experience designed for the entire rheumatology community. ACR Convergence is not just another meeting - it's where inspiration and opportunity unite to create an unmatched educational experience. For more information about the meeting, visit, or join the conversation on Twitter by following the official hashtag (#ACR20).

About the American College of Rheumatology

The American College of Rheumatology (ACR) is an international medical society representing over 7,700 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.


Antimalarial Drug Shortages During the COVID-19 Pandemic: Results from the Global Rheumatology Alliance Patient Experience Survey


Early in the COVID-19 pandemic, hydroxychloroquine and chloroquine were empirically promoted and used for treatment and prevention of SARS-CoV-2 infection. The repurposing of these drugs before robust efficacy data were available led to potentially harmful shortages for people with rheumatic diseases. The aims of this study were to assess (1) whether the use of antimalarials in patients with rheumatic disease was associated with a lower risk of COVID-19 infection, and (2) the prevalence and impact of drug shortages during the COVID-19 pandemic.


The COVID-19 Global Rheumatology Alliance (C19-GRA) Patient Experience Survey was distributed online through patient support organizations and on social media. Patients with rheumatic diseases (or the parents of pediatric patients) anonymously entered data including their rheumatic disease diagnosis, medications, COVID-19 status, and disease outcomes. Impact of drug shortages was evaluated for the effect on patient disease activity, mental health and physical health states by comparing mean values with two-sided independent t-tests to identify significant differences.


From 9,393 respondents (mean age 46.1 (SD 12.8) years, 90.0% female), 3,872 (41.2%) were taking antimalarials (Table 1). Of these, 230 (6.2%) were unable to continue taking antimalarials because of a lack of supply at their pharmacy. 21.4% of patients in South-East Asia and 26.7% in African regions reported an inadequate supply of antimalarials in pharmacies, in contrast to 6.8% of patients in the Americas and 2.1% in European regions. There were similar rates of COVID-19 infection among patients on antimalarials as compared to patients not on these drugs (6.7% vs. 4.7%). A total of 28 patients (10.8%) with COVID-19 who were taking antimalarials were hospitalized. Of 519 patients diagnosed with COVID-19, 68 (13.1%) indicated they were prescribed antimalarials as a treatment for their COVID-19 infection.

Patients who were unable to obtain antimalarials from their pharmacies compared to those who did not experience medication shortages experienced higher levels of rheumatic disease activity (5.1 > 4.3, t(244) = 4.44, p < 0.001) (Figure 1) and poorer mental (5.8 < 6.3, t(252) = 3.82, p < 0.001) and physical health (5.6 < 6.4, t(254) = 5.97, p < 0.001) (Figure 2).


Patients in African and South-East Asian regions reported greater difficulty obtaining antimalarial drugs to treat their rheumatic disease in contrast to patients in the Americas and European regions. Patients who experienced antimalarial drug shortages reported worse mental and physical health outcomes than those able to obtain their medications. Antimalarials did not protect patients with rheumatic disease from COVID-19 or from hospitalization as a result of COVID-19. The unintended harmful consequences of repurposing antimalarials, without adequate evidence for benefit, highlights the importance of maintaining scientific rigor even in the context of a pandemic. Regional disparities of access to medications should be addressed to ensure all people, particularly those living in developing countries, receive fair and equitable access to these essential medications.

American College of Rheumatology

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