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Hydroxychloroquine shortages among patients with systemic lupus erythematosus during the COVID-19 pandemic: experience of the Systemic Lupus International Collaborating Clinics
  1. Arielle Mendel1,
  2. Sasha Bernatsky1,2,
  3. Anca Askanase3,
  4. Sang-Cheol Bae4,
  5. Ann Elaine Clarke5,
  6. Nathalie Costedoat-Chalumeau6,
  7. Dafna D Gladman7,
  8. Caroline Gordon8,9,
  9. John Hanly10,
  10. Søren Jacobsen11,
  11. Ken Kalunian12,
  12. Anselm Mak13,
  13. Marta Mosca14,
  14. Bernardo A Pons-Estel15,
  15. Guillermo Ruiz-Irastorza16,
  16. Murray Urowitz7,
  17. Évelyne Vinet1,2
  1. 1 Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
  2. 2 Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
  3. 3 Division of Rheumatology, Columbia University Irving Medical Center, New York, New York, USA
  4. 4 Division of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seongdong-gu, Republic of Korea
  5. 5 Division of Rheumatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  6. 6 Centre de Référence Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Hôpital Cochin, Paris, France
  7. 7 Lupus Program, Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
  8. 8 Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
  9. 9 Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  10. 10 Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
  11. 11 Copenhagen Lupus and Vasculitis Clinic, Section 4242, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
  12. 12 Division of Rheumatology, University of California San Diego School of Medicine, La Jolla, California, USA
  13. 13 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  14. 14 Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
  15. 15 Regional Center for Autoimmune and Rheumatic Diseases of Rosario, Sanatorio Parque, Rosario, Argentina
  16. 16 Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
  1. Correspondence to Dr Arielle Mendel, Rheumatology, McGill University Health Centre, Montreal, QC H3G1A4, Canada; arielle.mendel{at}

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Early scientific and public enthusiasm for hydroxychloroquine (HCQ) as a potential therapy for COVID-19 has prompted over 100 registered trials to date, although its efficacy remains to be demonstrated.1 Unfortunately, accelerated demand for HCQ has the potential to diminish supplies for patients with systemic lupus erythematosus (SLE), which is worrisome due to the known risks of SLE flare after HCQ withdrawal.2 We previously reported that rheumatologists in most Canadian provinces observed HCQ shortages early in the COVID-19 pandemic.3 However, data are lacking on the global experience with HCQ access during the pandemic, specifically in SLE.

On 4 May 2020, we distributed an electronic survey to the 42 Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) members affiliated with SLE referral centres (, with reminders after 1 and 3 weeks. Physicians were asked about experiences with HCQ shortages during the COVID-19 pandemic, and whether they had been contacted by patients and/or pharmacists regarding difficulties accessing HCQ. Physicians who answered ‘yes’ to the latter question were asked to estimate how many and what proportion …

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  • Handling editor Josef S Smolen

  • Contributors AM, SB, EV: conception or design of the study; data acquisition, analysis and interpretation; drafting the work; revising it critically for important intellectual content; final approval of the version published. AA, S-CB, AEC, NC-C, DDG, CG, JH, SJ, KK, AM, MM, BAP-E, GR-I, MU: data analysis and interpretation; revising the work critically for important intellectual content; final approval of the version published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AEC reports consulting fees (less than $10 000) from Bristol Myers Squibb, Exagen Diagnostics and AstraZenca, outside the submitted work.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The McGill University Research Ethics Board approved this survey.

  • Provenance and peer review Not commissioned; externally peer reviewed.