Atlanta, GA—Before this year, primary care providers and specialists who routinely prescribed hydroxychloroquine, such as rheumatologists and dermatologists, issued nearly all, approximately 97%, of new prescriptions.

With the COVID-19 pandemic and promotion of the drug as a coronavirus cure—subsequently debunked—new prescriptions by specialists who did not typically prescribe these medications, defined as specialties accounting for ≤2% of new prescriptions before 2020, increased from 1,143 prescriptions in February 2020 to 75,569 in March 2020, an 80-fold increase from March 2019, according to a report from the CDC.

In an article in the Morbidity & Mortality Weekly Report, CDC researchers analyzed outpatient retail pharmacy transaction data to identify potential differences in prescriptions for hydroxychloroquine and chloroquine dispensed by provider type during January–June 2020, compared with the same period in 2019.

“Although dispensing trends are returning to pre-pandemic 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 report notes.

The study team examined hydroxychloroquine and chloroquine prescriptions dispensed through outpatient retail pharmacies in the United States during January–June 2019 and January–June 2020 using deidentified pharmacy transactions from the IQVIA National Prescription Audit database.

The CDC notes that hydroxychloroquine and chloroquine are primarily used to treat autoimmune diseases and to prevent and treat malaria. This year, however, the drugs received national attention in early March 2020, as potential treatment and prophylaxis for coronavirus disease 2019 (COVID-19). In fact, in March, the FDA issued an emergency use authorization (EUA) for chloroquine phosphate and hydroxychloroquine sulfate in the Strategic National Stockpile to be used by licensed healthcare providers to treat patients hospitalized with COVID-19 when the providers determine the potential benefit outweighs the potential risk to the patient. The next month, after reports of cardiac and other adverse events in patients receiving hydroxychloroquine for COVID-19, FDA issued a caution against its use, and, in June, rescinded its EUA for hydroxychloroquine from the Strategic National Stockpile.

Despite recommendations against the drugs’ usage by the federal COVID-19 Treatment Guidelines Panel, “public discussion concerning the effectiveness of these drugs on outcomes of COVID-19 and clinical trials of hydroxychloroquine for prophylaxis of COVID-19 continue,” the authors state.

Hydroxychloroquine and chloroquine prescriptions dispensed through outpatient retail pharmacies in the United States during January–June 2019 and January–June 2020 were examined using deidentified pharmacy transactions from the IQVIA National Prescription Audit database. This database includes 92% of all outpatient retail prescriptions dispensed in the United States; prescription estimates were projected by IQVIA to represent all retail, outpatient medication dispensing at the state and national levels.

For the study, researchers categorized clinicians prescribing hydroxychloroquine or chloroquine based on the frequency of prescribing of those drugs before the COVID-19 pandemic.

Results indicate that, overall, 54% of new prescriptions in March and April 2020 were written by primary care prescribers. Primary care prescribers wrote more new prescriptions than did routine prescribers the first month—10,350 dispensed prescriptions in 2019 compared with 108,705 in 2020, a 10.5-fold increase. Primary care prescribers continued to be the largest source of new prescriptions in April 2020, writing 67,055 prescriptions (63% of total new prescriptions).

During the same time period, nonroutine prescribers accounted for the largest percentage increase in new prescriptions compared with the same period in 2019—81.3-fold and 18.1-fold increases in March and April, respectively. The study reports that the nonroutine prescribing specialties with the highest prescribing volume and growth in March 2020 were ophthalmology, anesthesiology, and cardiology.

“A large increase in new prescriptions occurred for adult males (16.1-fold increase in March 2020 compared with March 2019). This increase in hydroxychloroquine prescribing for males is notable given that females are historically more likely to receive a new hydroxychloroquine prescription for autoimmune disease, consistent with described prevalence of autoimmune disorders among females (78%),” according to the authors, who point out that by May and June 2020, the numbers of new prescriptions and the number of new prescriptions from nonroutine prescribing specialties had declined and were approaching those of 2019, possibly influenced by clinical studies showing lack of effectiveness for the medications.

Background information in the articles describes how the drugs are routinely prescribed for lupus and rheumatoid arthritis (hydroxychloroquine) and for antimalarial prophylaxis malaria treatment (chloroquine), and that the annual rate of prescribing has not varied substantially from year to year.

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