Assessing the Effect of Antimalarial Drug Shortages in Rheumatic Disease During the COVID-19 Pandemic

Patients with rheumatic diseases from African and South-East Asian regions vs American and European regions reported greater difficulty in obtaining antimalarial drugs during the coronavirus disease 2019 (COVID-19) pandemic and had worse mental and physical outcomes, according to survey results presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually between November 5 to 9, 2020. Results also indicated that antimalarial drugs for rheumatic disease treatment did not have a protective effect against COVID-19 infection or hospitalizations as a result of COVID-19.

To assess the effect of antimalarial drug shortages during the COVID-19 pandemic in patients with rheumatic diseases, the COVID-19 Global Rheumatology Alliance Patient Experience Survey was distributed online to patients or parents of pediatric patients who anonymously entered relevant data, including rheumatic disease diagnosis, medications, COVID-19 status, and disease outcomes. The primary outcome measure was the effect of drug shortages on patient disease activity, mental health, and physical health.

Of 9393 survey respondents (mean age, 46.1±12.8 years; 90.0% women), 6334 (67.4%) were White and 1576 (16.8%) were Latin American. A majority of patients (70.9%) were also receiving conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

Among 3872 respondents receiving antimalarial drugs, 230 (6.2%) discontinued treatment due to drug shortages at their pharmacy. Compared with 6.8% of patients in the Americas and 2.1% in European regions, 21.4% in South-East Asia and 26.7% in African regions were affected by the inadequate supply of antimalarial drugs.

Overall, there were similar rates of COVID-19 infection among patients who received antimalarial drugs vs those who did not (6.7% vs 4.7%, respectively). Of 519 patients who were diagnosed with COVID-19, 68 (13.1%) indicated that their antimalarial medications were prescribed for the treatment of COVID-19 infection.

Patients who were unable vs able to obtain their antimalarial medications experienced higher levels of rheumatic disease activity (5.1 vs 4.3; t(244)=4.44; P <.001), poorer mental health (5.8 vs 6.3; t(252)=3.82; P <.001), and poorer physical health (5.6 vs 6.4; t(254)=5.97; P <.001).

Patients in certain regions, particularly Africa and South-East Asia, were found to be more affected by antimalarial drug shortages, a reminder of the “unintended harmful consequence of repurposing antimalarials without adequate evidence or benefit,” emphasizing “the importance of maintaining scientific rigor even in the context of a pandemic,” the study authors concluded.

Disclosures: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Sirotich E, Kennedy K, Surangiwala S, et al. Antimalarial drug shortages during the COVID-19 pandemic: results from the global rheumatology alliance patient experience survey. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0007.