Hydroxychloroquine and Chloroquine Prescribing Patterns by Provider Specialty Following Initial Reports of Potential Benefit for COVID-19 Treatment - United States, January-June 2020

Abstract

Hydroxychloroquine and chloroquine, primarily used to treat autoimmune diseases and to prevent and treat malaria, received national attention in early March 2020, as potential treatment and prophylaxis for coronavirus disease 2019 (COVID-19) (1). On March 20, the Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for chloroquine phosphate and hydroxychloroquine sulfate in the Strategic National Stockpile to be used by licensed health care providers to treat patients hospitalized with COVID-19 when the providers determine the potential benefit outweighs the potential risk to the patient.* Following reports of cardiac and other adverse events in patients receiving hydroxychloroquine for COVID-19 (2), on April 24, 2020, FDA issued a caution against its use^† and on June 15, rescinded its EUA for hydroxychloroquine from the Strategic National Stockpile.^§ Following the FDA's issuance of caution and EUA rescindment, on May 12 and June 16, the federal COVID-19 Treatment Guidelines Panel issued recommendations against the use of hydroxychloroquine or chloroquine to treat COVID-19; the panel also noted that at that time no medication could be recommended for COVID-19 pre- or postexposure prophylaxis outside the setting of a clinical trial (3). However, public discussion concerning the effectiveness of these drugs on outcomes of COVID-19 (4,5), and clinical trials of hydroxychloroquine for prophylaxis of COVID-19 continue.^¶ In response to recent reports of notable increases in prescriptions for hydroxychloroquine or chloroquine (6), CDC analyzed outpatient retail pharmacy transaction data to identify potential differences in prescriptions dispensed by provider type during January-June 2020 compared with the same period in 2019. Before 2020, primary care providers and specialists who routinely prescribed hydroxychloroquine, such as rheumatologists and dermatologists, accounted for approximately 97% of new prescriptions. 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. Although dispensing trends are returning to prepandemic 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 (3,4), 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.

FIGURE 1

Estimated refill/switch and new retail prescriptions for hydroxychloroquine or chloroquine dispensed in the United States — January–June, 2019–2020 * Refill/switch prescriptions include dispensed prescriptions that were either a refill of an existing prescription or a new prescription for a different dose or a brand switch.

FIGURE 2

Estimated new retail prescriptions of hydroxychloroquine or chloroquine dispensed, by prescriber category — United States, January–June, 2019–2020 * Nonroutine prescribers = addiction medicine, allergy/immunology, anesthesiology, cardiology, cardiothoracic surgery, cardiovascular surgery, clinical neurophysiology, clinical pharmacology, colon and rectal surgery, critical care, critical care medicine, dentistry, dermatopathology, diagnostic laboratory, diagnostic laboratory immunology, emergency medicine, endocrinology, gastroenterology, general preventive medicine, general surgery, genetics, geriatric psychiatry, geriatrics, hematology, hepatology, hospice and palliative medicine, infectious disease, medical microbiology, naturopathic doctor, neurological surgery, neurology, neurosurgery-critical care, nuclear medicine, nutrition, obstetrics/gynecology, obstetrics/gynecology-critical care, occupational medicine, oncology, ophthalmology, optometry, orthopedic surgery, orthopedic surgery of spine, other, other surgery, otolaryngology, otology, pain medicine, pathology, pediatric critical care, pediatric neurosurgery, pharmacist, physical medicine and rehab, plastic surgery, podiatry, psychiatry, psychology, pulmonary critical care, pulmonary diseases, radiology, sleep medicine, sports medicine, surgery, thoracic surgery, and urology. Primary care/unspecified prescribers = family practice, general practice, internal medicine, internal medicine/pediatrics, nurse practitioner, osteopathic medicine, pediatrics, physician assistant, and specialty unspecified. Routine prescribers = allergy, dermatology, nephrology, and rheumatology.