COVID-19 demand makes lupus drug scarce

An increasing number of doctors are prescribing a drug used to treat lupus and other autoimmune conditions to anyone demanding the medication, has led to a shortage, triggering concern within the medical fraternity.

With lupus patients complaining that they are unable to get the drug, the Association of Consultant Physicians of Jamaica (ACPJ) has issued a call to doctors to stop the reckless practise of prescribing the medication as a treatment against the novel coronavirus (COVID-19) and related symptoms.

“The Association of Consultant Physicians of Jamaica is aware of the recent increase in the writing of prescriptions by physicians for the drug hydroxychloroquine (HCQ) at this time. The ACPJ is recommending that physicians review the acceptable and ethical indications for the prescription of this and related pharmaceuticals normally used in the treatment of rheumatoid arthritis, systemic lupus and related conditions,” read a statement from the ACPJ, signed by Dr Mike Mills.

Dr Ernestine Watson, president of the Pharmaceutical Society of Jamaica (PSJ) said the increase in the number of prescriptions for the medication have caused pharmacies to run low on supply and in some instances, pharmacies are out of stock.

“There was an increase in the number of prescriptions for the medication. Basically each pharmacy will know their patients because these are chronic patients and if you have a new patient, the prescribing pattern and the other medication on the prescription, as well as the doctor that this coming from, you can determine if it is a patient with an autoimmune disease,” Dr Watson said.

“There was an increase of prescription coming for the hydroxychloroquine and so as pharmacists we started having a conversation about it, but as well as the pharmacists, the physicians were noticing that the specialists who were dealing with the patients with autoimmune conditions were describing that the patients were having a difficulty accessing the drug. Based on inquiries, we realised the physicians were prescribing, apparently, as prophylaxis (preventive treatment) for the COVID-19,” she added.

Subsequently, concerns were raised as the drug being out of stock can have adverse effects on individuals dependent on it for survival.

Further, Dr Watson also said the two main distributors of the HCQ drug are reporting that they are out of stock and at this moment, the manufacturers are unable to meet the demand.

“There is a little problem because normally distributors order based on their pattern of purchasing. They would normally order enough that would last for say a three months supply. With the increase, it became short and the usual manufacturers coming out of India are seemingly not able to supply outside their country for the moment. So, there is an issue but the NHF [National Health Fund]has been approached and they will be looking at ways to get the medication in for distribution,” Dr Watson said.

The ACPJ further outlined that there is no regulatory approval for the off-label use of the drug to treat COVID-19. The statement further pointed out that while there are early reports in the medical literature and wider media looking at the drug as an agent alone or in combination to treat a subset of COVID-19 patients, the findings are inconclusive.

Besides, the ACPJ said any use outside the already established off-label use is entirely experimental and associated with risk to the patient. Should the drug be used for COVID-19, the ACPJ suggests it be done in the setting of informed consent and ideally a clinical trial.

Local bariatric and laparoscopic surgeon, Dr Alfred Dawes, also addressed the issue at a recent Kiwanis Club of New Kingston meeting, where he urged individuals to be mindful that the drug is not approved to be used as a COVID-19 treatment.

“Some people have come requesting prescription for it and as a result the ACPJ issued a statement saying doctors should refrain from prescribing it. It is a drug in limited supply and those with lupus and other autoimmune diseases would still need their monthly supply. People are hoarding this medication, stocking up just in case they or a family member will need this drug, but the efficacy of it is still in doubt,” he said.

Meanwhile, Dr Watson referred to a study that was released last week to determine the effectiveness of the drug.

She said: “It showed that the patient in those studies who seem to benefit more from the drugs are persons who are not yet at the stage where they need the ICU [Intensive Care Unit]. Patients who are moderate seem to be more responsive to the HCQ as opposed to somebody who may be more severe in ICU. That is what the latest study seems to be saying, but these are not large enough studies to give definitive responses,” she stated.

Moreover, Dr Watson appealed to physicians to weigh the pros and cons of prescribing the HCQ before doing so.

“The benefit to the COVID-19 patient is not established. We like to speak of evidence- based medicine. Right now, the evidence does not fully support the HCQ being used as a treatment option. It is still being investigated as opposed to the lupus patient who has been controlled on the medication. That evidence supports HCQ. If I was a physician who is prescribing I would want to go with the evidence-based medicine. Weigh those things and where the greater benefit is, make that choice,” she said.

The PSJ president further encouraged members of the public to stay home, self- isolate, quarantine and keep their distance in order to help fight the COVID-19.

“If you take it seriously we will see results. Italy is having a decrease in cases because for the first time, the population is taking it seriously. Stay at home, ensure you are washing your hands and exercising the respiratory hygiene and the next thing is to look out for your neighbour; look out for the next person,” Dr Watson.

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