About half of hospitals' requests for an arthritis drug used to treat acute COVID-19 patients aren't being fulfilled as supplies run short, according to new data.
The Food and Drug Administration granted an emergency use authorization in June for Actemra, Roche's biologic that's mainly used for rheumatoid arthritis, to treat severely ill adults and pediatric patients hospitalized with COVID-19. Actemra has helped reduce risk of death and boosted recovery for patients who were receiving steroids and require supplemental oxygen, ventilation or extracorporeal membrane oxygenation, the agency said.
The average demand for intravenous Actemra surged 279% from mid-June to early August, according to data from the group purchasing organization Vizient. Fill rates for hospitals dropped from 99% to 45% over that period.
While hospitals have been able to source Eli Lily's Olumiant as an alternative, neither drug was made to meet the current demand, said Steven Lucio, senior principal of pharmacy solutions for Vizient. Actemra has been in short supply since Aug. 17, according to the FDA.
"It's hard to justify diverting something from one critically ill person to another who may not have alternatives," Lucio said, noting that the workarounds and ethical dilemmas are further straining healthcare workers. "The Actemra shortage has caused a lot of heartache and tough ethical decisions."
Although Actemra is used in only 4.5% of hospitalized COVID -19 patients, they tend to have higher lengths of stay, intensive care utilization and mortality rates, Vizient data show. More than 40% of COVID-19 patients who received Actemra were also treated with invasive ventilation.
Demand for Olumiant spiked 1,421% from mid-June to early August. But fill rates only dropped from 99% to 89% over that span. Fill rates for dexamethasone and remdesivir, which are also used for critically ill COVID-19 patients, have also remained relatively steady.
But painkillers used for patients on ventilators have periodically been in short supply. Hospital fill rates of intravenous analgesics dropped from 93% to 81% from early July to early August, according to Vizient.
As for rheumatoid arthritis patients, the first choice is typically for AbbVie's top-selling drug Humira. If a patient is on Actemra, that likely means that other drugs didn't work. Changing course can be dangerous, Lucio said, adding that Actemra is also used for CAR T-cell therapy. The subcutaneous version of Actemra is not authorized for COVID-19 patients.
"Rheumatoid arthritis can be quite variable," Lucio said. "If someone has gotten to Actemra, they more than likely failed other drugs and physicians don't want to disrupt treatment."
Global sales of Actemra have increased 17% from $1.46 billion in the first half of 2020 to $1.64 billion through the quarter ended June 30.
