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Disclosures: The authors report no relevant financial disclosures.
July 06, 2020
2 min read

Hydroxychloroquine, azithromycin prescriptions skyrocket amid early days of COVID-19

Disclosures: The authors report no relevant financial disclosures.
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Dispensed prescriptions of hydroxychloroquine in the U.S. increased 86.2%, while such prescriptions of chloroquine increased 158.6% from February to March 2020, data show.

The report in JAMA Internal Medicine also showed that the percentage of patients receiving both hydroxychloroquine and azithromycin prescriptions increased 1,044% during the same time period.

Percentage increase in dispensed prescriptions from February to March 2020: Hydroxychloroquine = 86.2% / Chloroquine = 158.6% / Hydroxychloroquine and Azithromycin = 1,044%
Reference: Shehab N, et al. JAMA Intern Med. 2020;doi:10.1001/jamainternmed.2020.2594.

Nadine Shehab, PharmD, MPH, of the CDC’s COVID-19 Response Team, and colleagues used information from the IQVIA Total Patient Tracker, a database that compiles initial prescriptions and refills paid for by commercial third parties, Medicaid, Medicare Part D or cash. According to researchers, the database typically records about 3.5 billion transactions from 92% of the United States’ retail pharmacies annually.

From October 2019 through February 2020, the estimated mean number of dispensed outpatient monthly hydroxychloroquine and chloroquine prescriptions was stagnant, the researchers reported. From February to March, every state and the District of Columbia recorded increases in dispensed hydroxychloroquine or chloroquine prescriptions. The largest such increases occurred in some of the states with the largest number of COVID-19 cases, including New Jersey (193.8%); Florida (156.7%); Hawaii (129.9%) and New York (123.3%). The lowest increases took place in South Dakota (37.4%) and Iowa (44.4%).

The researchers noted that the data do not include information on prescribing indication, “so not all increased dispensing may be for COVID-19.” They added that the data were collected before many treatment guidelines were released.

“As COVID-19 continues to spread, ongoing assessment of the use of potential therapies will be essential to inform safe and appropriate treatment, along with prompt adverse event reporting to FDA’s MedWatch safety reporting program,” Shehab and colleagues wrote, adding that “state-specific data can help target efforts to improve prescribing.”

The use of hydroxychloroquine, an anti-malarial drug commonly used by rheumatologists for rheumatoid arthritis, lupus and other conditions, to treat COVID-19 has been debated. In March, President Donald J. Trump surprised some in the medical community by promoting hydroxychloroquine as a COVID-19 treatment and on March 30, the FDA issued an emergency authorization of drug for that purpose.

Then about 6 weeks later, the ACP published a review concluding that the current evidence was insufficient to support using hydroxychloroquine and chloroquine to treat COVID-19. On June 15, the FDA rescinded its emergency use authorization for hydroxychloroquine for COVID-19 patients, in part because “the known and potential benefits of chloroquine and hydroxychloroquine no longer outweighed the known and potential risks for the authorized use.” However, last week, researchers conducting a multi-hospital assessment of 2,541 patients at the Henry Ford Health System in Detroit wrote in the International Journal of Infectious Diseases that when controlling for COVID-19 risk factors, treatment with hydroxychloroquine alone and in combination with azithromycin caused a drop in COVID-19-associated mortality.