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How has the COVID-19 pandemic affected our rheumatology patients using biological/targeted DMARDs?
Semih Gulle1, Yesim Erez1, Ali Karakas1
1Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
Insights
During the COVID-19 pandemic, about one-fifth of inflammatory rheumatic disease patients delayed biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) treatment. However, with good patient communication, treatment was successfully restarted, showing high 12-month drug retention rates.
Area of Science:
- Rheumatology
- Infectious Diseases
- Pharmacology
Background:
- The COVID-19 pandemic significantly impacted healthcare delivery and patient management.
- Patients with inflammatory rheumatic musculoskeletal diseases (iRMD) on b/tsDMARDs faced unique challenges and concerns regarding treatment continuity.
- Understanding the pandemic's effects on iRMD treatment is crucial for maintaining patient health and drug efficacy.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic on the treatment course of iRMD patients using b/tsDMARDs.
- To analyze treatment delays and identify factors influencing drug retention during the pandemic.
- To assess the risk of SARS-CoV-2 infection in iRMD patients based on their treatment and comorbidities.
Main Methods:
- A two-stage study design was employed to assess treatment delays and long-term retention.
- Data on 521 iRMD patients were analyzed, including diagnoses (e.g., SpA, RA) and medication use (b/tsDMARDs, hydroxychloroquine, glucocorticoids).
- Statistical analysis, including hazard ratios (HR), was used to identify factors affecting drug retention and SARS-CoV-2 infection risk.
Main Results:
- Approximately 20% of iRMD patients on b/tsDMARDs delayed treatment in the initial 3 months of the pandemic due to COVID-19 fears.
- Factors reducing 12-month drug retention included concurrent hydroxychloroquine use, IV bDMARD administration, and initial treatment discontinuation.
- Glucocorticoid use and pre-existing interstitial lung disease/COPD significantly increased SARS-CoV-2 infection risk.
Conclusions:
- Despite initial treatment delays driven by pandemic-related fears, effective patient communication facilitated treatment resumption.
- High 12-month drug retention rates were observed, indicating the resilience of b/tsDMARD therapy in iRMD patients.
- Identifying risk factors for SARS-CoV-2 infection is vital for protecting vulnerable iRMD patients during pandemics.
Introduction:
We aimed to investigate the effects of the coronavirus disease 2019 (COVID-19) pandemic on the course and treatment of patients with inflammatory rheumatic musculoskeletal disease (iRMD) using biologic or targeted synthetic disease modifying and rheumatic drugs (b/tsDMARDs).
Methodology:
The study was carried out in two stages: in the first stage we investigated the delay of b/tsDMARD treatment in the first 3 months of the pandemic; in the second stage, we investigated all patients who decided to continue treatment after interruption in the 12-month period.
Results:
A total of 521 patients were included in the study. The iRMD diagnosis was listed as spondyloarthritis (SpA) (54.3%), rheumatoid arthritis (RA) (25.7%), psoriatic arthritis (PsA) (8.4%), vasculitis (6.1%), and others (5.4%). Concurrent use of hydroxychloroquine (hazard ratio [HR] = 1.49), iv bDMARD use (HR = 1.34), and a history of discontinuation of drug in the first 3 months of the pandemic (HR = 1.19) were determined as factors that reduced 12-month drug retention rates. The use of glucocorticoid (HR = 3.81) and having a diagnosis of interstitial lung disease/chronic obstructive lung disease (HR = 4.96) were found to increase the risk of being infected by SARS coronavirus 2 (SARS-CoV-2).
Conclusions:
It was shown that approximately 1/5 of iRMD patients using b/tsDMARDs delayed their treatment due to the fear of COVID-19 in the first three months of the pandemic process. However, with good communication with the patients, b/tsDMARD treatment was restarted and the 12-month drug retention status was quite high.
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