Profile of sales and notifications of suspected adverse events related to hydroxychloroquine and chloroquine during the COVID-19 pandemic
DOI:
https://doi.org/10.33448/rsd-v12i2.40021Keywords:
Drug-Related Side Effects and Adverse Reactions; Products Commerce; Hydroxychloroquine; Chloroquine; COVID-19.Abstract
The goal of this study is to describe the profile of hydroxychloroquine sales and reports of suspected adverse events related to chloroquine and hydroxychloroquine during the COVID-19 pandemic. This is a descriptive study which data were extracted from the Industrialized Drug Sales Panel and the Pharmacovigilance Notification Panel. The results show that 1.862.978 boxes of hydroxychloroquine were sold in the period of April 01,2020 to August 31,2021, with an average of 109.586 boxes sold per month (median=110.318; minimum=72.042; maximum=187.752). Also, 1.064 notifications involving chloroquine or hydroxychloroquine were realized in the period of March 01,2020 to August 31, 2021 and more than half of them (n=617.57.8%) were documented by June 2020, while only 40 were recorded in January/2021 to August/2021. These findings were correlated with scientific evidence, as in vitro and preliminary studies, published at the beginning of the pandemic, found important results regarding the use of these medications to treat COVID-19. However, in mid-2020, more robust studies indicated that these agents were not effective in treating or preventing COVID-19, and to being unsafe for the patient. Consequently, the use of these drugs in Brazilian hospitals had declined. This fact justified the reduction of notifications involving these drugs, since the detection and notification of adverse events often occur in the hospital environment, where the patient is constantly monitored. Despite the evidence that hydroxychloroquine is not effective to prevent/treat COVID-19, the sales profile remained high during the period evaluated indicating how the social and political incentive influenced Brazilians to use these medications.
References
Abella, B. S., Jolkovsky, E. L., Biney, B. T., Uspal, J. E., Hyman, M. C., Frank, I., Hensley, S. E., Gill, S., Vogl, D. T., Maillard, I., Babushok, D. V., Huang, A. C., Nasta, S. D., Walsh, J. C., Wiletyo, E. P., Gimotty, P. A., Milone, M. C., & Amaravadi, R. K. (2021). Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis Among Health Care Workers. JAMA Internal Medicine, 181(2), 195. https://doi.org/10.1001/jamainternmed.2020.6319
Agência Nacional de Vigilância Sanitária. (2020a). Resolução nº 351, de 20 de março de 2020. http://www.planalto.gov.br/ccivil_03/portaria/Resolucao%20nº%20351-ANVISA.htm
Agência Nacional de Vigilância Sanitária. (2020b). Resolução nº 405, de 22 de julho de 2020. https://www.in.gov.br/en/web/dou/-/resolucao-de-diretoria-colegiada-rdc-n-405-de-22-de-julho-de-2020-268192342
Agência Nacional de Vigilância Sanitária. (2021a). Notificações de farmacovigilância. https://www.gov.br/anvisa/pt-br/acessoainformacao/dadosabertos/informacoes-analiticas/notificacoes-de-farmacovigilancia
Agência Nacional de Vigilância Sanitária. (2021b). Venda de Medicamentos Controlados e Antimicrobianos, Medicamentos Industrializados. https://app.powerbi.com/view?r=eyJrIjoiMjU0ZmY3YTktMzMwNy00MDRkLTk4MGItMWFjYzM0MzMwNDMwIiwidCI6ImI2N2FmMjNmLWMzZjMtNGQzNS04MGM3LWI3MDg1ZjVlZGQ4MSJ9
Araújo, R. F., Oliveira, T. M. (2020). Desinformação e mensagens sobre a hidroxicloroquina no Twitter: da pressão política à disputa científica. AtoZ: novas práticas em informação e conhecimento. https://doi.org/10.5380/atoz.v9i2.75929
Associação de Medicina Intensiva Brasileira. (2021). Nota de esclarecimento AMIB sobre o uso de cloroquina e hidroxicloroquina em crianças e adolescentes com COVID-19. https://www.amib.org.br/covid-19-diretrizes/nota-de-esclarecimento-amib-sobre-o-uso-de-cloroquina-e-hidroxicloroquina-em-criancas-e-adolescentes-com-covid-19/.
Axfors, C., Schmitt, A. M., Janiaud, P., van’t Hooft, J., Abd-Elsalam, S., Abdo, E. F., Abella, B. S., Akram, J., Amaravadi, R. K., Angus, D. C., Arabi, Y. M., Azhar, S., Baden, L. R., Baker, A. W., Belkhir, L., Benfield, T., Berrevoets, M. A. H., Chen, C.-P., Chen, T.-C., ... Hemkens, L. G. (2021). Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nature Communications, 12(1). https://doi.org/10.1038/s41467-021-22446-z
Bradley, S. M., Emmons-Bell, S., Mutharasan, R. K., Rodriguez, F., Gupta, D., Roth, G., Gluckman, T. J., Shah, R. U., Wang, T. Y., Khera, R., Peterson, P. N., & Das, S. (2021). Repeated cross-sectional analysis of hydroxychloroquine deimplementation in the AHA COVID-19 CVD Registry. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-94203-7
Conselho Nacional de Saúde. (2020). CNS recomenda ao Ministério da Saúde plano de abastecimento de cloroquina para pacientes com doenças crônicas e patologias. http://conselho.saude.gov.br/ultimas-noticias-cns/1323-cns-recomenda-ao-ministerio-da-saude-plano-de-abastecimento-de-cloroquina-para-pacientes-com-doencas-cronicas-e-patologias
Cortegiani, A., Ingoglia, G., Ippolito, M., Giarratano, A., & Einav, S. (2020). A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. Journal of Critical Care, 57, 279–283. https://doi.org/10.1016/j.jcrc.2020.03.005
Cui, C., Tu, S., En, V. S. J., Li, X., Yao, X., Li, H., & Liu, D. (2020). Review on the Clinical Pharmacology of Hydroxychloroquine Sulfate for the Treatment of COVID-19. Current Drug Metabolism, 21(6), 427–435. https://doi.org/10.2174/1389200221666200610172929
De Crescenzo, F., Amato, L., Cruciani, F., Moynihan, L. P., D’Alò, G. L., Vecchi, S., Saulle, R., Mitrova, Z., Di Franco, V., Addis, A., & Davoli, M. (2021). Comparative Effectiveness of Pharmacological Interventions for COVID-19: A Systematic Review and Network Meta-Analysis. Frontiers in Pharmacology, 12. https://doi.org/10.3389/fphar.2021.649472
Fantini, J., Chahinian, H., & Yahi, N. (2020). Synergistic antiviral effect of hydroxychloroquine and azithromycin in combination against SARS-CoV-2: What molecular dynamics studies of virus-host interactions reveal. International Journal of Antimicrobial Agents, 56(2), 106020. https://doi.org/10.1016/j.ijantimicag.2020.106020
Gautret, P., Lagier, J. C., Parola, P., Hoang, V. T., Meddeb, L., Mailhe, M., Doudier, B., Courjon, J., Giordanengo, V., Vieira, V. E., Tissot Dupont, H., Honoré, S., Colson, P., Chabrière, E., La Scola, B., Rolain, J.-M., Brouqui, P., & Raoult, D. (2020). Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents, 56(1), 105949. https://doi.org/10.1016/j.ijantimicag.2020.105949
Huang, M., Tang, T., Pang, P., Li, M., Ma, R., Lu, J., Shu, J., You, Y., Chen, B., Liang, J., Hong, Z., Chen, H., Kong, L., Qin, D., Pei, D., Xia, J., Jiang, S., & Shan, H. (2020). Treating COVID-19 with Chloroquine. Journal of Molecular Cell Biology, 12(4), 322–325. https://doi.org/10.1093/jmcb/mjaa014
Ibáñez, S., Martínez, O., Valenzuela, F., Silva, F., & Valenzuela, O. (2020). Hydroxychloroquine and chloroquine in COVID-19: should they be used as standard therapy? Clinical Rheumatology, 39(8), 2461–2465. https://doi.org/10.1007/s10067-020-05202-4
Infectious Diseases Society of America. (2021). COVID-19 Guideline, Part 1: Treatment and Management. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/
Magagnoli, J., Narendran, S., Pereira, F., Cummings, T. H., Hardin, J. W., Sutton, S. S., & Ambati, J. (2020). Outcomes of Hydroxychloroquine Usage in United States Veterans Hospitalized with COVID-19. Med, 1(1), 114–127.e3. https://doi.org/10.1016/j.medj.2020.06.001
Melo, J. R. R., Duarte, E. C., & Arrais, P. S. D. (2021). Notificação de eventos adversos de medicamentos no Brasil: perfil dos profissionais que notificam ao sistema de farmacovigilância brasileiro. Cadernos de Saúde Pública, 37(11). https://doi.org/10.1590/0102-311x00237221
Melo, J. R. R., Duarte, E. C., Moraes, M. V. d., Fleck, K., Silva, A. S. d. N. e., & Arrais, P. S. D. (2021). Reações adversas a medicamentos em pacientes com COVID-19 no Brasil: análise das notificações espontâneas do sistema de farmacovigilância brasileiro. Cadernos de Saúde Pública, 37(1). https://doi.org/10.1590/0102-311x00245820
Meo, S. A., Klonoff D.C., & Akram J. (2020). Efficacy of chloroquine and hydroxychloroquine in the treatment of COVID-19. Eur Rev Med Pharmacol Sci, 24(8):4539-4547. https://doi.org/10.26355/eurrev_202004_21038
Ministério da Saúde. (2020a). Diretrizes para diagnóstico e tratamento da COVID-19. https://saude.rs.gov.br/upload/arquivos/202004/14140600-2-ms-diretrizes-covid-v2-9-4.pdf
Ministério da Saúde. (2020b). Protocolo de manejo clínico para o novo-coronavírus. https://bvsms.saude.gov.br/bvs/publicacoes/manejo_clinico_covid-19_atencao_especializada.pdf
Neves, A. L. M. D., & Ferreira, B. D. O. (2020). Narrativas entre ciência e política no ativismo da cloroquina. Psicologia & Sociedade, 32. https://doi.org/10.1590/1807-0310/2020v32240338
Oliveira, J. V. L., Costa, F. B. D., Porfírio, V. N., Silva, M. M. M. D., Cunha, A. B. O. C., Silva, N. C., Nascimento, V. J. O. A., França, A. M. M., Melo, M. L. R. S., Silva, R. F. C., Costa, M. D. T., & Silva Filho, L. S. (2021). A automedicação no período de pandemia de COVID-19: Revisão integrativa. Research, Society and Development, 10(3), Artigo e58610313762. https://doi.org/10.33448/rsd-v10i3.13762
Oliveira, P., Viana, C. C. V., Neto, O. H. C., Pereira, G. G., Santos, A. S., & Zocratto, K. B. F. (2020). Cloroquina e hidroxicloroquina: uso off-label em processos judiciais no estado de Minas Gerais. Cadernos Ibero-Americanos de Direito Sanitário, 9(4), 102–116. https://doi.org/10.17566/ciads.v9i4.715
Organização Pan-Americana da Saúde. (2020). OMS afirma que COVID-19 é agora caracterizada como pandemia. https://www.paho.org/pt/news/11-3-2020-who-characterizes-covid-19-pandemic
Organização Pan-Americana da Saúde. (2021). Entenda a infodemia e a desinformação na luta contra a COVID-19. https://iris.paho.org/handle/10665.2/52054
Pacheco, T. J. A., De Souza, D. G., De Lima, L. I., & Longo, J. P. F. (2020). Panorama mundial de estudos com a hidroxicloroquina para o tratamento da COVID-19. Journal of Health & Biological Sciences, 8(1), 1. https://doi.org/10.12662/2317-3076jhbs.v8i1.3288.p1-4.2020
Penaforte, T. R. (2021). O negacionismo enquanto política: o debate da cloroquina em uma comissão parlamentar. Cadernos de Saúde Pública, 37(7). https://doi.org/10.1590/0102-311x00023021
Rosenberg, E. S., Dufort, E. M., Udo, T., Wilberschied, L. A., Kumar, J., Tesoriero, J., Weinberg, P., Kirkwood, J., Muse, A., DeHovitz, J., Blog, D. S., Hutton, B., Holtgrave, D. R., & Zucker, H. A. (2020). Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State. JAMA, 323(24), 2493. https://doi.org/10.1001/jama.2020.8630
Santos, J. R. M. d., Monteiro, L., Sousa, S. G. d., & Araújo, B. G. d. (2021). The risks of hydroxychlorochine self-medication in front of the COVID-19 Pandemic. Brazilian Journal of Health Review, 4(3), 11185–11204. https://doi.org/10.34119/bjhrv4n3-123
Soares, F. B., Viegas, P., Bonoto, C., & Recuero, R. (2021). COVID-19, desinformação e Facebook: circulação de URLs sobre a hidroxicloroquina em páginas e grupos públicos. Galáxia (São Paulo), 46. https://doi.org/10.1590/1982-2553202151423
Sociedade Brasileira de Infectologia. (2020). Informe da Sociedade Brasileira de Infectologia sobre o novo coronavírus n° 15: uso de medicamentos para COVID-19. https://infectologia.org.br/wp-content/uploads/2020/07/Informe-15-uso-de-medicamentos-para-covid-19.pdf
Sociedade Brasileira de Pneumologia e Tisiologia. (2020). Declaração sobre o tratamento da COVID-19. https://sbpt.org.br/portal/wp-content/uploads/2020/07/declaracao_tratamento_covid.pdf
The RECOVERY Collaborative Group. (2020). Effect of Hydroxychloroquine in Hospitalized Patients with COVID-19. New England Journal of Medicine, 383(21), 2030–2040. https://doi.org/10.1056/nejmoa2022926
Vincent, M. J., Bergeron, E., Benjannet, S., Erickson, B. R., Rollin, P. E., Ksiazek, T. G., Seidah, N. G., & Nichol, S. T. (2005). Chloroquine is a potent inhibitor of SARS infection and coronavirus. Virology Journal, 2(1), 69. https://doi.org/10.1186/1743-422x-2-69
WHO Solidarity Trial Consortium. (2020). Repurposed Antiviral Drugs for COVID-19 — Interim WHO Solidarity Trial Results. New England Journal of Medicine. 384, 497-511, https://doi.org/10.1056/nejmoa2023184
Wiersinga, W. J., Rhodes, A., Cheng, A. C., Peacock, S. J., & Prescott, H. C. (2020). Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19). JAMA, 324(8), 782. https://doi.org/10.1001/jama.2020.12839
Wilder-Smith, A., Chiew, C. J., & Lee, V. J. (2020). Can we contain the COVID-19 outbreak with the same measures as for SARS? The Lancet Infectious Diseases, 20(5). https://doi.org/10.1016/s1473-3099(20)30129-8
World Health Organization. (2022a). “Solidarity” clinical trial for COVID-19 treatments. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments
World Health Organization. (2022b). Therapeutics and COVID-19: living guideline. https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2022.4
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