Hydroxychloroquine (Plaquenil) and Chloroquine Shortage Caused by COVID-19 Coronavirus Claims

Is there a shortage of Hydroxychloroquine (Plaquenil) or chloroquine?

Yes. There have been recent shortages of these drugs, which are important medications for people with lupus and those with rheumatoid arthritis. Hydroxychloroquine (Plaquenil) and chloroquine (formerly known as Aralen) are very similar. Chloroquine was developed first, but hydroxychloroquine became preferred because it has fewer side effects.

Recent anecdotal reports and studies in test tubes have suggested that these drugs may also help treat COVID-19, the pandemic illness caused by the new coronavirus . It was this news that caused recent shortages. On March 19, 2020, however, Mylan, a manufacturer of hydroxychloroquine, announced it would accelerate production in the United States, and Teva, another pharmaceutical company,  announced that it will supply millions of doses to the United States. Other companies have also scaled up their production of this drug, and we anticipate that drug shortages will soon be alleviated.

What will happen if I have lupus or rheumatoid arthritis and can’t get my Plaquenil or chloroquine?

The good news outweighs the bad. Generally, if your pharmacy can’t fill your prescription, you’re safe for at least several weeks or longer. If you can, get advance prescriptions now in case the drug does become hard to get later. Most patients can miss doses for a few weeks without developing a disease flare, so long as they can restart it again when the drug is available.

This was shown in a study published in 1991 by a group of Canadian doctors. To understand whether patients with lupus who are doing well while taking hydroxychloroquine need to continue taking it, the researchers randomized 50 patients (who had been taking the drug for at least six months and who had been well for at least three months) to take a placebo or to continue the drug. For about the first three months, most patients in both groups did well. After six months, however, about 60% of patients who were on placebo suffered a flare, compared to about 25% of those who had continued the hydroxychloroquine. In other words, the drug is important, but it takes a long time for illness to flare up. Learn more about the findings of this study.

Why might it take three months or longer before I have a flare without my medication?

Unlike most drugs that work when blood levels rise a few hours after taking a pill, chloroquine and hydroxychloroquine need to saturate the body to be effective. This is why it takes about three months from starting the drug to see its effect. If you stop taking the drug, it takes about three months to get rid of that which your body has stored.

Can Hydroxychloroquine (Plaquenil) or chloroquine treat the COVID-19 Coronavirus?

This is unproven, but it is being studied. A very small study in China, which provided almost no details, suggested that COVID-19 patients who were treated with chloroquine had somewhat milder cases – shorter hospital stays – than did those who were not. The study suggested that chloroquine should be tried as a therapy for all COVID-19 cases. Test tube (in vitro) experiments suggested a possible reason why this might be so, since the drug appears to slow the virus’s spread. The Chinese study did not say that survival was better or that taking chloroquine prevented illness.

Another very small study in France, with substantial limitations on how it was conducted, also suggested clinical efficacy of hydroxychloroquine. These findings were overinterpreted by news media outlets and promoted by public leaders. There is no evidence at present that it is a "game changer." Nonetheless, many physicians began prescribing the drug, and many patients began hoarding it. Fortunately, clinical trials are now underway to determine whether or not this drug helps patients with COVID-19. Hydroxychloroquine is not currently approved for use in the treatment of COVID-19, however, it is listed by the World Health Organization as a drug under investigation for efficacy against the coronavirus.

Authors

Image - Photo of Michael D. Lockshin, MD
Michael D. Lockshin, MD
Attending Rheumatologist, Hospital for Special Surgery
Director, Barbara Volcker Center for Women and Rheumatic Disease
 

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