In addition to seeing patients and managing their conditions, Edward Fudman, MD, a rheumatologist in Austin, Texas, has recently been doing a great deal of something else—rewriting a prescription he’s already written because of a drug shortage.
Patients more and more frequently have been going to the pharmacy only to be told that the prescribed drug is unavailable. When Dr. Fudman finds out that the brand-name drug is available, he often has to write another prescription.
“It’s just one more hassle in the day in a long list of hassles that don’t really have to do with taking care of patients,” Dr. Fudman says.
An Increasing Problem
The rate of drug shortages has been rising steadily in recent years, due to quality questions at manufacturers, consolidation in the drug-manufacturing industry, and other factors, according to data from the U.S. Food and Drug Administration (FDA) and other sources.
Much of the attention to the problem has centered on the shortage in cancer drugs, but rheumatology has seen its share of shortages, too, forcing patients to struggle in their search for medications, and sometimes adding to their pain and discomfort.
Drugs frequently prescribed by rheumatologists that were in short supply as of September 2011 include leflunomide tablets, injectable methotrexate, and metylprednisolone tablets. And there are many others in short supply now or that have been in short supply recently.
Kathryn Dao, MD, a rheumatologist at the Baylor Research Institute in Dallas and co-editor of the ACR’s Drug Safety Quarterly (DSQ), says it’s a worsening problem in rheumatology.
“We have been encountering more drug shortages lately,” she says. “Currently, it has been more of an annoyance than a problem, but I foresee this becoming a larger issue. We have been able to work around the shortages by finding appropriate substitutes that have similar efficacy, similar side effect profiles, and similar costs; however, I wonder how much longer we would be able to do this.”
John J. Cush, MD, co-editor of DSQ and director of clinical rheumatology at the Baylor Research Institute, says the shortages have been a source of headache for patient and physician.
“You have to find new ways to write for the drug, like different doses or use the original trade name to get the prescription filled,” he says. “It’s a major inconvenience for the patients and for the prescribing doctors.”
DSQ frequently lists drugs used in rheumatology that are in short supply.
