Providers have been purchasing significant amounts of chloroquine and hydroxychloroquine in anticipation that they will be used to treat COVID-19, drastically depleting available supply, according to a new report from Premier.
While the U.S. Food and Drug Administration is still investigating whether the inexpensive, old anti-malaria drugs can tame symptoms and limit the spread of the highly contagious virus, hospitals have responded to clinical trials in other countries that have shown promising results.
Orders of chloroquine spiked 3,000% in March, according to data from Premier, the group purchasing and consulting organization. From January 2019 through February 2020, hospitals ordered an average of 149 units a month. More than 2,300 units were ordered through March thus far.
Its variant hydroxychloroquine experienced a 260% surge in demand, Premier data show. Hospitals typically used about 8,800 units a month, jumping to 16,110 units ordered in March.
Chloroquine phosphate tables and hydroxychloroquine sulfate tablets went into shortage on March 9 and March 19, respectively, according to the American Society of Health System Pharmacists.
All major wholesale distributors put hydroxychloroquine and chloroquine on allocation this week, which limits ordering to prevent hoarding, Premier said.
"As additional reports come forth from countries suggesting treatment protocols for COVID-19, a single source of truth in the U.S. is needed to mitigate panic-buying," Premier said in the report. The Centers for Disease Control and Prevention should study the international data and make recommendations for treatment protocols domestically, Premier offered.
Chloroquine, which is also used to treat lupus and rheumatoid arthritis, isn't typically well stocked by hospitals, if at all, said Erin Fox, a drug shortage expert and senior director of drug information and support services at University of Utah Health.
"It's more of a travel medicine to be used for malaria treatment," said Fox, adding that University of Utah Health bought a small amount at the end of February to have on hand just in case when it saw some preliminary data from China. "We don't have a lot of malaria in the U.S. — probably why it was fine for just one company to supply the entire U.S."
While a single manufacturer produces chloroquine, four additional manufacturers are approved by the FDA to make it, Premier noted. There are 10 suppliers with FDA approval to produce hydroxychloroquine, but not all of them are currently manufacturing.
Some of the manufacturers of chloroquine and related products have lowered prices and donated millions of doses to the U.S. government.
Last month, the National Institutes of Health began a randomized controlled trial for the treatment of COVID-19 patients with Gilead Sciences' antiviral drug remdesivir. It is one of several drugs that are being tested for COVID-19 treatment, but quality and pricing questions remain.
"We understand and recognize the urgency with which we are all seeking prevention and treatment options for COVID-19. FDA staff are working expeditiously on that front," FDA Commissioner Dr. Stephen Hahn, said in prepared remarks. "We also must ensure these products are effective; otherwise we risk treating patients with a product that might not work when they could have pursued other, more appropriate, treatments."
The drug supply chain is already working around restricted access to pharmaceutical ingredients. The Indian government is limiting the export of 26 ingredients, some of which are used in widely used antibiotics, to protect its domestic supply amid the pandemic.
Much of the world's supply of generic drugs comes from India, which relies heavily on China for their active pharmaceutical ingredients.