Canadian prescriptions for malaria drug with COVID-19 potential surge, some for doctors’ own use

By | April 8, 2020

Some Canadian doctors appear to have been snapping up a malaria drug for their own possible use against COVID-19, part of a surge in prescriptions for the medicine that has health-care regulators across the country concerned.

Professional organizations in several provinces have issued statements in recent days discouraging the practice, noting there’s no solid evidence yet that hydroxychloroquine and a related medicine work against the coronavirus.

“As evidence-based clinicians, we must be diligent in our efforts to not let blind hope drive our decisions,” said a joint statement from the associations representing Ontario pharmacists, doctors and registered nurses.

We must be diligent in our efforts to not let blind hope drive our decisions

The Quebec Order of Pharmacists, which regulates that province’s druggists, recently urged its members not to fill prescriptions meant for COVID-19 prevention or treatment, calling them “inappropriate.”

The Alberta College of Pharmacists, another regulator, said it has received reports of physicians prescribing hydroxychloroquine for ” ‘office use’ to themselves, to family members and when there is no accepted indication (i.e., treatment of COVID-19 infection).”

Pharmacists in Ontario also received prescriptions “for office use.” It was unclear whether those physicians wanted a supply to dispense to patients — when many clinics were closed — or for themselves and family, said Allan Malek, chief pharmacy officer with the Ontario Pharmacists Association.

“Our message is that we have to exercise a little bit of control here and rational thinking,” he said Monday. “We’re asking for calm in this, and to let the studies unfold.”

Meanwhile, the increased prescription of the malaria medication as a coronavirus therapy is already creating shortages for patients with a proven need to take it, say their advocates.

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Hydroxychloroquine has long been a standard treatment for lupus and rheumatoid arthritis patients. But many of them have reported having trouble obtaining it, said Leanne Mielczarek, executive director of Lupus Canada.

“They are experiencing difficulty,” she said. “In some cases, patients have to go to multiple pharmacies to fill their prescriptions.”

The Canadian Rheumatology Association has heard from patients unable to fill prescriptions at all, or told they could only get a 30-day supply, after COVID-19-related prescribing “increased dramatically,” said Ahmad Zbib, the group’s CEO.

That scarcity could ironically affect coronavirus patients, too, should the large trials now in the works conclude that hydroxychloroquine is, in fact, useful in treating COVID-19.

Malek said his research indicates that three of the four approved producers of the medicine in Canada have no supply and the fourth has “very limited” stocks.

Health Canada is currently trying to find manufacturers in other countries who could add to this country’s reserves, he said.

Interest in hydroxychloroquine’s potential was first triggered by a small study from France that found it reduced the viral load in some patients. Lindsey Wasson/Reuters

The controversy is unfolding as U.S. President Donald Trump continues to promote the drug — in combination with the antibiotic azithromycin — as a potential COVID-19 “game changer.” On Sunday, Trump stopped Dr. Anthony Fauci, the administration’s chief infectious-disease expert, from answering a reporter’s question about the issue. Fauci has cautioned that more evidence is needed on hydroxychloroquine’s effectiveness against the coronavirus.

Interest in the malaria drug’s potential was first triggered by a small study from France that found it reduced the viral load in some patients, and a larger trial involving 80 patients that lacked a control group — patients who did not receive the hydroxychloroquine/azithromycin combination.

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A small Chinese study found some benefit, and another saw no difference between the patients who received the drugs and those who didn’t.

A number of fast-tracked, randomized controlled trials are now testing the medication on much larger groups of patients in Canada and elsewhere. Many experts argue the medicines should not be routinely used for COVID-19 until those studies issue findings in the coming weeks and months.

Echoing a similar phenomenon in the U.S., regulators and professional associations here say they started hearing about a spike in prescriptions late last month.

The only was to do this responsibly is to get good evidence, not to speculate

Demand grew significantly for hydroxychloroquine “in odd doses and quantities, with an off-label and unsubstantiated indication of ‘COVID-19 prophylaxis or treatment,’ ” said the Ontario associations in their joint statement. The result, they said, is a “very serious shortage.”

The regulators for Manitoba nurses, doctors and pharmacists reported a “significant increase” in prescriptions and resulting shortages because of “yet-to-be-proven claims.”

Similar warnings were issued in Alberta.

“We have to do this responsibly and the only was to do this responsibly is to get good evidence, not to speculate,” Greg Eberhart, registrar of the Alberta College of Pharmacy, said in an interview Monday.

B.C.’s regulators predicted that prescribers will face even more pressure from “patients, fellow health care workers and even friends and family” to help them access the drugs.

“Health professionals all have a responsibility … to focus only on evidence-based care and not yield to patient pressure around unproven and potentially dangerous uses of existing medications,” the groups said.

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