Shifting Hydroxychloroquine Patterns Raise Concern | Clinical Pharmacy and Pharmacology | JAMA | JAMA Network
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News From the Centers for Disease Control and Prevention
October 27, 2020

Shifting Hydroxychloroquine Patterns Raise Concern

JAMA. 2020;324(16):1600. doi:10.1001/jama.2020.20311

The number of hydroxychloroquine prescriptions by specialists who don’t typically prescribe the drug skyrocketed after preliminary reports in March suggested potential benefits for patients with coronavirus disease 2019 (COVID-19).

CDC investigators analyzed hydroxychloroquine and chloroquine prescriptions dispensed by US retail pharmacies from January through June 2019 and during the same period in 2020. Prior to 2020, the drugs were prescribed most often by primary care physicians or specialists like rheumatologists or dermatologists for autoimmune disorders or as malaria prophylaxis.

However, the analysis showed that prescriptions written by specialists who don’t typically use the drugs rose to 75 569 in March 2020 from 1143 in February 2020—an 80-fold increase compared with March 2019. Among specialists who don’t routinely prescribe hydroxychloroquine and chloroquine, the greatest growth in outpatient prescriptions in March 2020 was in the fields of ophthalmology, anesthesiology, and cardiology.

The investigators also documented unusual prescribing trends. Women, who account for 78% of patients with autoimmune diseases, received 81% of new hydroxychloroquine or chloroquine prescriptions in March and April 2019. A year later, men received about 40% of new prescriptions during those months.

The changes in prescribing led to shortages of the drugs and made it difficult for patients taking the drugs for chronic diseases to obtain them despite limited evidence of benefit for COVID-19.

“Although dispensing trends are returning to prepandemic levels, continued adherence to current clinical guidelines for the indicated use of these medications will ensure their availability and benefit to patients for whom their use is indicated, because current data on treatment and pre- or postexposure prophylaxis for COVID-19 indicate that the potential benefits of these drugs do not appear to outweigh their risks,” the authors wrote.