Ohio Association of Rheumatology Offers Perspective on the Use and Availability of Hydroxychloroquine and Chloroquine
posted: April 21, 2020
Hydroxychloroquine is a FDA-approved drug prescribed for the treatment of autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus and many more in addition to serving as an effective anti-malarial drug. Chloroquine phosphate is a similar drug to hydroxychloroquine and used for the same reasons, but is known to have more toxicity associated with its use. Recently, the Federal Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for chloroquine phosphate and hydroxychloroquine sulfate, also known as Plaquenil as the brand name, for certain hospitalized COVID-19 (SARS-CoV-2) patients. The EUA and recent media attention has placed scrutiny on both drugs’ safety and effectiveness. The public and our patient population have become concerned with the safety of hydroxychloroquine and chloroquine due to this media attention and the reports of some patient’s having toxicity from their use for the treatment of COVID-19.
Hydroxychloroquine and chloroquine are similar but not the same drug and were not used similarly in the treatment of COVID-19 patients. At times the doses of the medications used were higher than that typically prescribed for the treatment of autoimmune diseases. This needs to be taken into consideration when looking at the risks of these medications. There are current trials underway to look at the use of these drugs in COVID-19 patients, but there is no current definitive research showing they prevent infection or how well they help mitigate the COVID-19 disease progression. Nevertheless, the Ohio Association of Rheumatology (OAR) remains hopeful that the current studies underway will adjudicate recent claims regarding the use of these drugs for COVID-19. We urge caution among our colleagues and patients as well as the general public around just assuming that this treatment works without the research to show it does.
OAR supports the use of hydroxychloroquine as a clinically proven treatment for rheumatoid arthritis, systemic lupus erythematosus and other autoimmune diseases, which are chronic conditions that require continuous treatment for successful management of the diseases. The consequence of the general use of hydroxychloroquine and chloroquine for COVID-19 is that many thousands of patients who have been prescribed the medication for their autoimmune diseases may now be facing obstacles to obtain it. Concerns have risen within the rheumatology community around the reported shortage of hydroxychloroquine and chloroquine since they were placed on the FDA’s drug shortage list in March. Access to these medications is further strained by now being included in the Strategic National Stockpile.
Our organization applauds the Ohio State Board of Pharmacy for placing some restrictions on prescribing hydroxychloroquine and chloroquine to avert hoarding and inappropriate prescribing. We also appreciate the efforts of other government entities that are now issuing guidance on the specific use of these medications. Nevertheless, it is still unclear if enough is being done to prevent further shortages of the drug and future access as well.
OAR is committed to providing the highest quality of care for our patients and feel it is critical that patients who are stable on these medications not be denied access. We are concerned that a shortage of the drug will affect providers’ ability to continue to care for patients, many of which are among the frailest and most vulnerable during the COVID-19 pandemic.
Stephanie Ott, MD, FACP, FACR, MWRA
President, Ohio Association of Rheumatology