Prescription fill patterns of medications associated with potential benefits, as well as possible harms, during the coronavirus disease 2019 (COVID-19) pandemic were recently described in an exploratory analysis published in the Journal of the American Medical Association (JAMA).
“Limited data are available about how prescription of these therapies has changed,” the authors noted. They hypothesized that increases in hydroxychloroquine/chloroquine and azithromycin prescribing and decreases in angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) prescribing would likely be observed.
To investigate these changes, the authors compared trends in the average weekly prescriptions of hydroxychloroquine/chloroquine, azithromycin, and 10 commonly used medications (which included lisinopril and losartan) dispensed between February 16 and April 25, 2020 with those dispensed between February 17 and April 27, 2019. Approximately 17 million de-identified claims were included and were assigned weights to match data from the Medical Expenditures Panel Survey 2015-2017 in order to produce national estimates. Weekly fill estimates were obtained by scaling national estimates to total retail prescription drug fills in the US in 2019.
Results showed that the number of fills peaked for all medications except amoxicillin and hydrocodone-acetaminophen during the week of March 15 to 21, 2020. This peak was subsequently followed by a “modest” decline in fills for most common long-term medications, possibly due to reduced access to providers and pharmacies, loss of insurance, or low inventory caused by early stockpiling.
Findings of the study also revealed a large increase in hydroxychloroquine/chloroquine fills during March 15 to 21, 2020, especially for fills with lower tablet numbers (ie, <28 tablets). The authors hypothesized that this increase is likely attributed to the declaration of a global pandemic, the support of the drug by the US President, and a small study published during that week. Moreover, compared with a similar 10-week period in 2019, there was an excess of 483,425 fills for hydroxychloroquine/chloroquine between February 16 and April 25, 2020.
During the pandemic, there has been concern that ACE inhibitor and ARB use may be associated with increased susceptibility to COVID-19. “However, in this analysis, prescriptions of the most frequently used ACE inhibitor (lisinopril) and ARB (losartan) did not appear to substantially decline compared with other commonly prescribed medications for chronic conditions,” the authors reported.
Vaduganathan M, van Meijgaard J, Mehra MR, Joseph J, O’Donnell CJ, Warraich HJ. Prescription fill patterns for commonly used drugs during the COVID-19 Pandemic in the United States. JAMA. Published online May 28, 2020. doi: 10.1001/jama.2020.9184.