Sulfasalazine & hydroxychloroquine shortages easing

3 minute read

Some patients with RA have had a hard time accessing some medications over the past few months, with sulfasalazine and hydroxychloroquine in patchy supply.

Some patients with RA have had a hard time accessing some medications over the past few months, with sulfasalazine and hydroxychloroquine in patchy supply.

Fortunately, some of those supply issues appear to be easing now as sponsors are limiting the doses that pharmacists can distribute at any one time and the federal government has intervened to restrict access to key medications.

The sulfasalazine shortages began around December last year due to difficulties in manufacturing by the sole supplier, Pfizer.

NSW got supply back for Salazopyrin EN 500mg tablets on 13 July, but other states would have to wait until 27 July, according to a release from Pfizer.

“Once it is back in stock there will be processes put in place to manage supply,” Pfizer said.

Pyralin EN 500mg tablets were out of stock in NSW until 13 July but other states still had some stock.

“The supply of Pyralin EN tablets is currently being managed by only supplying the same quantity to pharmacies that has been ordered in the past 12 months + 4 extra bottles if needed. Please note this may change depending on stock levels,” Pfizer said.

These kinds of drug shortages are not uncommon (there are currently 61 listed on the TGA’s website) but the sulfasalazine shortage has been particularly hard on patients with RA, said Associate Professor Sean O’Neill, a rheumatologist at Royal North Shore Hospital in Sydney and the chair of the Therapeutics Committee for the ARA.

Anecdotally, patients with RA had found it difficult to fill their prescriptions but had eventually managed to get their hands on the drug, he said.

If patients with RA went without this medication for one to two weeks they might experience a flare and be put on other medications like prednisone to bring it under control, said Professor O’Neill. This wasn’t ideal because of the significant side effects associated with prednisone.

The hype around hydroxychloroquine as a potential treatment for COVID-19 caused significant supply issues in Australia in March and April.

In the early stages of the pandemic, it was quite trendy to prescribe this drug for the treatment of coronavirus and this ate into the supply that patients with rheumatic disease could access.

This was particularly painful for patients with lupus who depended on this medication to manage flares, said Professor O’Neill.

But the enthusiasm for hydroxychloroquine started to drop off as international clinical trial results rolled in showing the drug was not particularly ineffective, he said.

“It’s starting to fall out of favour with COVID,” he said.

There are five companies that supply hydroxychloroquine to Australia – Sanofi-Aventis, Generic Health, Amneal Pharmaceuticals, Arrow Pharmaceuticals and Apotex.

In March, the ARA took this issue to the federal Health Minister Greg Hunt and the Chief Medical Officer Professor Brendan Murphy and got the restrictions on hydroxychloroquine tightened up.

Under the new regulations, hydroxychloroquine can now only be prescribed with an authority prescription, meaning it can’t be prescribed off label for COVID-19 or any other condition or disease.

“To the credit of [Mr Hunt], the CMO, the TGA, and the PBS, they did actually move to restrict to this, and I believe that has been effective,” Professor O’Neill said.


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